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Niu Y, Buzzell GA, Cosmoiu A, Fox NA, Nelson CA, Zeanah CH, Humphreys KL. Foster Care Leads to Lower Irritability Among Adolescents with a History of Early Psychosocial Deprivation. Res Child Adolesc Psychopathol 2024; 52:1183-1192. [PMID: 38642277 PMCID: PMC11288996 DOI: 10.1007/s10802-024-01193-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 04/22/2024]
Abstract
Irritability reflects a propensity for frustration and anger, and is a transdiagnostic symptom of both externalizing and internalizing psychopathology. While early adverse experiences are associated with higher levels of irritability, experiences of early psychosocial deprivation and whether family-based placements can mitigate the impact on subsequent irritability, remain underexplored. The current study examined irritability in 107 16-year-olds with a history of institutional care from a randomized controlled trial of foster care as an alternative to institutional care and 49 community comparison children. At age 16 years, irritability was assessed using parent- and self-report forms of the Affective Reactivity Index. Compared to community adolescents, those with a history of institutional care exhibited significantly elevated irritability levels. Among those who experienced institutional care, those randomized to foster care had lower levels of irritability compared to participants randomized to the care-as-usual group, and this effect persists after controlling for baseline negative emotionality. These findings suggest a causal link between high-quality foster care and lower irritability following psychosocial deprivation. Additionally, longer duration in institutional care and non-family placement at age 16 years were associated with higher levels of irritability, highlighting the role of caregiving in explaining variation in irritability in adolescence. Policies that support long-term, high-quality family placements for children without regular caregivers should be prioritized.
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Affiliation(s)
- Yanbin Niu
- Department of Psychology & Human Development, Peabody College, Vanderbilt University, 230 Appleton Place, Nashville, TN, 37203, USA
| | - George A Buzzell
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Ana Cosmoiu
- Department of Psychology and Cognitive Sciences, University of Bucharest, Bucharest, Romania
| | - Nathan A Fox
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, USA
| | - Charles A Nelson
- Boston Children's Hospital of Harvard Medical School, Boston, MA, USA
- Harvard Graduate School of Education, Cambridge, MA, USA
| | - Charles H Zeanah
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - Kathryn L Humphreys
- Department of Psychology & Human Development, Peabody College, Vanderbilt University, 230 Appleton Place, Nashville, TN, 37203, USA.
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Archer C, Meza-Cervera T, Scheinberg B, Kircanski K, Brotman MA, Pine DS, Leibenluft E, Linke JO. Irritability, Negative Life Events and the Course of Anxiety and Depressive Symptoms in a Clinical Sample of Youth: A Longitudinal Study. JAACAP OPEN 2024; 2:45-54. [PMID: 38699439 PMCID: PMC11062628 DOI: 10.1016/j.jaacop.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Objective Irritability, the tendency to react with anger, and the experience of negative life events (NLE) have independently been associated with the emergence of anxiety and depression. Here, we investigate how irritability and cumulative effects of NLE interactively predict the course of anxiety and depression in the context of common psychiatric disorders. Method 432 youth with no psychiatric diagnosis, or a diagnosis of an anxiety disorder, Attention-Deficit/ Hyperactivity Disorder (ADHD), or Disruptive Mood Dysregulation Disorder (DMDD), participated in this study. At baseline, we assessed NLE, parent and youth reports of irritability and anxiety, and youth reports of depression. Symptoms were annually reassessed for up to four years. Results In youth without psychiatric diagnoses but with elevated baseline irritability, the presence of NLE predicted decreasing anxiety, while the absence of NLE predicted increasing anxiety. In youth with an anxiety disorder, elevated baseline irritability predicted decreasing anxiety independent of NLE, while a large cumulative effect of NLE predicted increasing depression. NLE predicted persisting mild anxiety in ADHD and persisting mild depressive symptoms in DMDD. Conclusion Our findings suggest that, particularly in non-referred samples, NLE might moderate the relationship between irritability and future anxiety such that irritability/ anger in the context of NLE can positively affect the course of anxiety. Future work replicating this finding while repeatedly measuring NLE and rigorously controlling for potentially confounding effects of treatment, is warranted.
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Affiliation(s)
- Camille Archer
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Tatiana Meza-Cervera
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Brooke Scheinberg
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Melissa A Brotman
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Daniel S Pine
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
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Ravi S, Havewala M, Kircanski K, Brotman MA, Schneider L, Degnan K, Almas A, Fox N, Pine DS, Leibenluft E, Filippi C. Parenting and childhood irritability: Negative emotion socialization and parental control moderate the development of irritability. Dev Psychopathol 2023; 35:1444-1453. [PMID: 35039102 PMCID: PMC9289071 DOI: 10.1017/s0954579421001346] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Irritability, characterized by anger in response to frustration, is normative in childhood. While children typically show a decline in irritability from toddlerhood to school age, elevated irritability throughout childhood may predict later psychopathology. The current study (n = 78) examined associations between trajectories of irritability in early childhood (ages 2-7) and irritability in adolescence (age 12) and tested whether these associations are moderated by parenting behaviors. Results indicate that negative emotion socialization moderated trajectories of irritability - relative to children with low stable irritability, children who exhibited high stable irritability in early childhood and who had parents that exhibited greater negative emotion socialization behaviors had higher irritability in adolescence. Further, negative parental control behavior moderated trajectories of irritability - relative to children with low stable irritability, children who had high decreasing irritability in early childhood and who had parents who exhibited greater negative control behaviors had higher irritability in adolescence. In contrast, positive emotion socialization and control behaviors did not moderate the relations between early childhood irritability and later irritability in adolescence. These results suggest that both irritability in early childhood and negative parenting behaviors may jointly influence irritability in adolescence. The current study underscores the significance of negative parenting behaviors and could inform treatment.
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Affiliation(s)
- Sanjana Ravi
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Mazneen Havewala
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, USA
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Melissa A. Brotman
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Leslie Schneider
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Kathryn Degnan
- Department of Psychology, Catholic University of America, Washington, DC, USA
| | - Alisa Almas
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Nathan Fox
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, USA
| | - Daniel S. Pine
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Courtney Filippi
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
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4
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Linke JO, Haller SP, Xu EP, Nguyen LT, Chue AE, Botz-Zapp C, Revzina O, Perlstein S, Ross AJ, Tseng WL, Shaw P, Brotman MA, Pine DS, Gotts SJ, Leibenluft E, Kircanski K. Persistent Frustration-Induced Reconfigurations of Brain Networks Predict Individual Differences in Irritability. J Am Acad Child Adolesc Psychiatry 2023; 62:684-695. [PMID: 36563874 PMCID: PMC11224120 DOI: 10.1016/j.jaac.2022.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 10/07/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Aberrant responses to frustration are central mechanisms of pediatric irritability, which is a common reason for psychiatric consultation and a risk factor for affective disorders and suicidality. This pilot study aimed to characterize brain network configuration during and after frustration and test whether characteristics of networks formed during or after frustration relate to irritability. METHOD During functional magnetic resonance imaging, a transdiagnostic sample enriched for irritability (N = 66, mean age = 14.0 years, 50% female participants) completed a frustration-induction task flanked by pretask and posttask resting-state scans. We first tested whether and how the organization of brain regions (ie, nodes) into networks (ie, modules) changes during and after frustration. Then, using a train/test/held-out procedure, we aimed to predict past-week irritability from global efficiency (Eglob) (ie, capacity for parallel information processing) of these modules. RESULTS Two modules present in the baseline pretask resting-state scan (one encompassing anterior default mode and temporolimbic regions and one consisting of frontoparietal regions) contributed most to brain circuit reorganization during and after frustration. Only Eglob of modules in the posttask resting-state scans (ie, after frustration) predicted irritability symptoms. Self-reported irritability was predicted by Eglob of a frontotemporal-limbic module. Parent-reported irritability was predicted by Eglob of ventral-prefrontal-subcortical and somatomotor-parietal modules. CONCLUSION These pilot results suggest the importance of the postfrustration recovery period in the pathophysiology of irritability. Eglob in 3 specific posttask modules, involved in emotion processing, reward processing, or motor function, predicted irritability. These findings, if replicated, could represent specific intervention targets for irritability.
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Affiliation(s)
- Julia O Linke
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland.
| | - Simone P Haller
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Ellie P Xu
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Lynn T Nguyen
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Amanda E Chue
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Christian Botz-Zapp
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Olga Revzina
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Samantha Perlstein
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Andrew J Ross
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Wan-Ling Tseng
- Yale Child Study Center, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Philip Shaw
- Neurobehavioral Clinical Research Section, Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, Maryland
| | - Melissa A Brotman
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Daniel S Pine
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Stephen J Gotts
- Section on Cognitive Neuropsychology, Laboratory of Brain and Cognition, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
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Mathew A, Lockwood MB, Steffen AD, Jiwan Tirkey A, Pavamani S, Patil CL, Doorenbos AZ. Distinct Dysphagia Profiles in Patients With Oral Cancer After Surgery. Oncol Nurs Forum 2023; 50:201-214. [PMID: 37677804 PMCID: PMC10900126 DOI: 10.1188/23.onf.201-214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
OBJECTIVES To determine distinct profiles based on symptom severity in patients undergoing surgery for oral cancer and examine whether these profiles differ by participant characteristics. SAMPLE & SETTING 300 patients who underwent surgery for oral cancer at two outpatient clinics between June and December 2021. METHODS & VARIABLES Symptoms were assessed using the MD Anderson Symptom Inventory-Head and Neck Cancer Module. Sociodemographic and clinical characteristics were collected. Latent profile analysis was performed. RESULTS Five distinct dysphagia profiles were identified, which qualitatively differed regarding co-occurrence patterns of dysphagia, mucus-related symptoms, speech disturbances, and psychoneurologic symptoms. Significant differences were reported in interference to function, number of co-occurring symptoms, time since diagnosis and treatment completion, use of symptom management medications, oral cancer stage and site, and treatment completed. IMPLICATIONS FOR NURSING Identifying distinct dysphagia profiles can improve patient outcomes and help in planning specific nursing interventions to influence nutritional and functional status in oral cancer survivors. Dysphagia and dry mouth can persist beyond one year post-treatment, so follow-up dysphagia assessments are needed.
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6
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Lee KS, Hagan CN, Hughes M, Cotter G, McAdam Freud E, Kircanski K, Leibenluft E, Brotman MA, Tseng WL. Systematic Review and Meta-analysis: Task-based fMRI Studies in Youths With Irritability. J Am Acad Child Adolesc Psychiatry 2023; 62:208-229. [PMID: 35944754 PMCID: PMC9892288 DOI: 10.1016/j.jaac.2022.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 04/22/2022] [Accepted: 07/28/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Childhood irritability, operationalized as disproportionate and frequent temper tantrums and low frustration tolerance relative to peers, is a transdiagnostic symptom across many pediatric disorders. Studies using task-dependent functional magnetic resonance imaging (fMRI) to probe neural dysfunction in irritability have increased. However, an integrated review summarizing the published methods and synthesized fMRI results remains lacking. METHOD We conducted a systematic search using irritability terms and task functional neuroimaging in key databases in March 2021, and identified 30 studies for our systematic review. Sample characteristics and fMRI methods were summarized. A subset of 28 studies met the criteria for extracting coordinate-based data for quantitative meta-analysis. Ten activation-likelihood estimations were performed to examine neural convergence across irritability measures and fMRI task domains. RESULTS Systematic review revealed small sample sizes (median = 58, mean age range = 8-16 years) with heterogeneous sample characteristics, irritability measures, tasks, and analytical procedures. Meta-analyses found no evidence for neural activation convergence of irritability across neurocognitive functions related to emotional reactivity, cognitive control, and reward processing, or within each domain. Sensitivity analyses partialing out variances driven by heterogeneous tasks, irritability measures, stimulus types, and developmental ages all yielded null findings. Results were compared with a review on irritability-related structural anomalies from 11 studies. CONCLUSION The lack of neural convergence suggests a need for common, standardized irritability assessments and more homogeneous fMRI tasks. Thoughtfully designed fMRI studies probing commonly defined neurocognitive functions may be more fruitful to elucidate the neural mechanisms of irritability. Open science practices, data mining in large neuroscience databases, and standardized analytical methods promote meaningful collaboration in irritability research.
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Affiliation(s)
- Ka Shu Lee
- Yale School of Medicine, New Haven, Connecticut; University of Oxford, United Kingdom.
| | | | - Mina Hughes
- Yale School of Medicine, New Haven, Connecticut
| | | | - Eva McAdam Freud
- Yale School of Medicine, New Haven, Connecticut.,University College London, United Kingdom, and Anna Freud National
Centre for Children and Families, London, United Kingdom
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Longitudinal Associations Between Peer Victimization and Emotional Difficulties in Schoolchildren: The Role of Sleep Quality. SCHOOL MENTAL HEALTH 2022. [DOI: 10.1007/s12310-022-09558-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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8
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Hodgdon EA, Courtney KE, Yan M, Yang R, Alam T, Walker JC, Yu Q, Takarae Y, Cordeiro Menacho V, Jacobus J, Wiggins JL. White matter integrity in adolescent irritability: A preliminary study. Psychiatry Res Neuroimaging 2022; 324:111491. [PMID: 35635933 PMCID: PMC9676048 DOI: 10.1016/j.pscychresns.2022.111491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/01/2022] [Accepted: 05/08/2022] [Indexed: 11/16/2022]
Abstract
Irritability is a prevalent, impairing transdiagnostic symptom, especially during adolescence, yet little is known about irritability's neural mechanisms. A few studies examined the integrity of white matter tracts that facilitate neural communication in irritability, but only with extreme, disorder-related symptom presentations. In this preliminary study, we used a group connectometry approach to identify white matter tracts correlated with transdiagnostic irritability in a community/clinic-based sample of 35 adolescents (mean age = 14 years, SD = 2.0). We found positive and negative associations with irritability in local white matter tract bundles including sections of the longitudinal fasciculus; frontoparietal, parolfactory, and parahippocampal cingulum; corticostriatal and thalamocortical radiations; and vertical occipital fasciculus. Our findings support functional neuroimaging studies that implicate widespread neural pathways, particularly emotion and reward networks, in irritability. Our findings of positive and negative associations reveal a complex picture of what is "good" white matter connectivity. By characterizing irritability's neural underpinnings, targeted interventions may be developed.
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Affiliation(s)
- Elizabeth A Hodgdon
- Department of Psychology, San Diego State University, San Diego, CA, United States.
| | - Kelly E Courtney
- Department of Psychiatry, University of California, San Diego, CA, United States
| | - Marvin Yan
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | - Ruiyu Yang
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | - Tasmia Alam
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | - Johanna C Walker
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, United States
| | - Qiongru Yu
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, United States
| | - Yukari Takarae
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | | | - Joanna Jacobus
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, United States; Department of Psychiatry, University of California, San Diego, CA, United States
| | - Jillian Lee Wiggins
- Department of Psychology, San Diego State University, San Diego, CA, United States; Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, United States
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Uçar HN, Çetin FH, Türkoğlu S. Perceived Expressed Emotion and Irritability in Adolescents With Attention-Deficit/Hyperactivity Disorder Inattentive Type: The Moderating Effect of Subtype. J Psychosoc Nurs Ment Health Serv 2022; 60:11-20. [PMID: 35522933 DOI: 10.3928/02793695-20220429-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The current study aimed to investigate perceived expressed emotion (EE) and irritability among adolescents with inattentive and combined type attention-deficit/hyperactivity disorder (ADHD-I and ADHD-C, respectively), and to assess whether the subtype plays a moderating role in the relationship between perceived EE and irritability. The current cross-sectional, case-control study comprised 37 adolescents with ADHD-I, 62 adolescents with ADHD-C, and 58 age- and sex-matched adolescents without ADHD. After controlling for confounding factors, adolescents with ADHD-C were found to exhibit significantly higher levels of perceived lack of emotional support than adolescents with ADHD-I (p = 0.029). Results of moderation analysis showed ADHD subtype to be a moderating factor in the relationship between perceived EE and irritability. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].
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Schultze-Lutter F, Walger P, Franscini M, Traber-Walker N, Osman N, Walger H, Schimmelmann BG, Flückiger R, Michel C. Clinical high-risk criteria of psychosis in 8–17-year-old community subjects and inpatients not suspected of developing psychosis. World J Psychiatry 2022; 12:425-449. [PMID: 35433326 PMCID: PMC8968502 DOI: 10.5498/wjp.v12.i3.425] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/26/2021] [Accepted: 09/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In children and adolescents compared to adults, clinical high-risk of psychosis (CHR) criteria and symptoms are more prevalent but less psychosis-predictive and less clinically relevant. Based on high rates of non-converters to psychosis, especially in children and adolescents, it was suggested that CHR criteria were: (1) Pluripotential; (2) A transdiagnostic risk factor; and (3) Simply a severity marker of mental disorders rather than specifically psychosis-predictive. If any of these three alternative explanatory models were true, their prevalence should differ between persons with and without mental disorders, and their severity should be associated with functional impairment as a measure of severity.
AIM To compare the prevalence and severity of CHR criteria/symptoms in children and adolescents of the community and inpatients.
METHODS In the mainly cross-sectional examinations, 8–17-year-old community subjects (n = 233) randomly chosen from the population register of the Swiss Canton Bern, and inpatients (n = 306) with primary diagnosis of attention-deficit/hyperactivity disorder (n = 86), eating disorder (n = 97), anxiety including obsessive–compulsive disorder (n = 94), or autism spectrum disorder (n = 29), not clinically suspected to develop psychosis, were examined for CHR symptoms/criteria. Positive items of the Structured Interview for Psychosis-Risk Syndromes (SIPS) were used to assess the symptomatic ultra-high-risk criteria, and the Schizophrenia Proneness Instrument, Child and Youth version (SPI-CY) was used to assess the 14 basic symptoms relevant to basic symptom criteria. We examined group differences in frequency and severity of CHR symptoms/criteria using χ2 tests and nonparametric tests with Cramer’s V and Rosenthal’s r as effect sizes, and their association with functioning using correlation analyses.
RESULTS The 7.3% prevalence rate of CHR criteria in community subjects did not differ significantly from the 9.5% rate in inpatients. Frequency and severity of CHR criteria never differed between the community and the four inpatient groups, while the frequency and severity of CHR symptoms differed only minimally. Group differences were found in only four CHR symptoms: suspiciousness/persecutory ideas of the SIPS [χ2 (4) = 9.425; P = 0.051, Cramer’s V = 0.132; and Z = -4.281, P < 0.001; Rosenthal’s r = 0.184], and thought pressure [χ2 (4) = 11.019; P = 0.026, Cramer’s V = 0.143; and Z = -2.639, P = 0.008; Rosenthal’s r = 0.114], derealization [χ2 (4) = 32.380; P < 0.001, Cramer’s V = 0.245; and Z = -3.924, P < 0.001; Rosenthal’s r = 0.169] and visual perception disturbances [χ2 (4) = 10.652; P = 0.031, Cramer’s V = 0.141; and Z = -2.822, P = 0.005; Rosenthal’s r = 0.122] of the SPI-CY. These were consistent with a transdiagnostic risk factor or dimension, i.e., displayed higher frequency and severity in inpatients, in particular in those with eating, anxiety/obsessive–compulsive and autism spectrum disorders. Low functioning, however, was at most weakly related to the severity of CHR criteria/symptoms, with the highest correlation yielded for suspiciousness/persecutory ideas (Kendall’s tau = -0.172, P < 0.001).
CONCLUSION The lack of systematic differences between inpatients and community subjects does not support suggestions that CHR criteria/symptoms are pluripotential or transdiagnostic syndromes, or merely markers of symptom severity.
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Affiliation(s)
- Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf 40629, North-Rhine Westphalia, Germany
- Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya 60286, Indonesia
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 3000, Switzerland
| | - Petra Walger
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf 40629, North-Rhine Westphalia, Germany
| | - Maurizia Franscini
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zürich, Zürich 8032, Germany
| | - Nina Traber-Walker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zürich, Zürich 8032, Germany
| | - Naweed Osman
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf 40629, North-Rhine Westphalia, Germany
| | - Helene Walger
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich 80336, Bavaria, Germany
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 3000, Switzerland
- University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Rahel Flückiger
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 3000, Switzerland
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 3000, Switzerland
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Lee KS, Xiao J, Luo J, Leibenluft E, Liew Z, Tseng WL. Characterizing the Neural Correlates of Response Inhibition and Error Processing in Children With Symptoms of Irritability and/or Attention-Deficit/Hyperactivity Disorder in the ABCD Study®. Front Psychiatry 2022; 13:803891. [PMID: 35308882 PMCID: PMC8931695 DOI: 10.3389/fpsyt.2022.803891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD), characterized by symptoms of inattention and/or hyperactivity and impulsivity, is a neurodevelopmental disorder associated with executive dysfunctions, including response inhibition and error processing. Research has documented a common co-occurrence between ADHD and pediatric irritability. The latter is more characterized by affective symptoms, specifically frequent temper outbursts and low frustration tolerance relative to typically developing peers. Shared and non-shared neural correlates of youths with varied profiles of ADHD and irritability symptoms during childhood remain largely unknown. This study first classified a large sample of youths in the Adolescent Brain Cognitive Development (ABCD) study at baseline into distinct phenotypic groups based on ADHD and irritability symptoms (N = 11,748), and then examined shared and non-shared neural correlates of response inhibition and error processing during the Stop Signal Task in a subset of sample with quality neuroimaging data (N = 5,948). Latent class analysis (LCA) revealed four phenotypic groups, i.e., high ADHD with co-occurring irritability symptoms (n = 787, 6.7%), moderate ADHD with low irritability symptoms (n = 901, 7.7%), high irritability with no ADHD symptoms (n = 279, 2.4%), and typically developing peers with low ADHD and low irritability symptoms (n = 9,781, 83.3%). Latent variable modeling revealed group differences in the neural coactivation network supporting response inhibition in the fronto-parietal regions, but limited differences in error processing across frontal and posterior regions. These neural differences were marked by decreased coactivation in the irritability only group relative to youths with ADHD and co-occurring irritability symptoms and typically developing peers during response inhibition. Together, this study provided initial evidence for differential neural mechanisms of response inhibition associated with ADHD, irritability, and their co-occurrence. Precision medicine attending to individual differences in ADHD and irritability symptoms and the underlying mechanisms are warranted when treating affected children and families.
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Affiliation(s)
- Ka Shu Lee
- Department of Experimental Psychology, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, United States
| | - Jingyuan Xiao
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, United States
- Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, United States
| | - Jiajun Luo
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, United States
- Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, United States
- Institute for Population and Precision Health, The University of Chicago, Chicago, IL, United States
| | - Ellen Leibenluft
- Section on Mood Dysregulation and Neuroscience, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Zeyan Liew
- Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, United States
| | - Wan-Ling Tseng
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, United States
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12
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Lee KS, Xiao J, Liew Z, Gau SSF, Tseng WL. Perinatal and birth correlates of childhood irritability in Taiwan's national epidemiological study. J Affect Disord 2022; 299:273-280. [PMID: 34906640 PMCID: PMC8767526 DOI: 10.1016/j.jad.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 12/03/2021] [Accepted: 12/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Childhood irritability, characterized by low frustration tolerance and developmentally-inappropriate temper outbursts, is a transdiagnostic symptom in child psychiatry. Little is known regarding the influences of early experience and environmental exposure on irritability from a perinatal perspective. This study examined the associations between irritability and multiple perinatal and birth factors. METHODS Drawn Taiwan's National Epidemiological Study of Child Mental Disorders, 5124 children (2591 females) aged 7.7 to 14.6 years (mean 11.2 years) and their parents completed the Affective Reactivity Index, a well-established irritability measure. Parents completed a survey on parental, perinatal, and birth characteristics. Multiple linear regression models were performed to examine the associations between perinatal and birth characteristics and child irritability reported across informants. RESULTS Maternal smoking, vaginal bleeding, and pre-eclampsia during pregnancy and phototherapy for jaundice >3 days were associated with high irritability after adjusting for child's age, sex, and parental characteristics. Findings were consistent across parent- and child-rated irritability. LIMITATIONS Retrospective assessment of early exposures may be subject to recall bias despite previously-established validity and reliability. Longitudinal research with prospective assessments of early life exposures is recommended to confirm our findings. This exploratory approach of multiple survey items also precludes more in-depth assessments of perinatal risks for developing irritability. CONCLUSIONS This study provides novel evidence suggesting a perinatal link with irritability in a national sample of youths. Given that irritability predicts adverse mental health and life outcomes, identifying its perinatal and birth predictors may inform early etiology, guiding timely assessment and intervention.
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Affiliation(s)
- Ka Shu Lee
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, United States,Division of Psychology and Language Sciences, Faculty of Brain Sciences, University College London, London, United Kingdom,Department of Experimental Psychology, Division of Medical Sciences, University of Oxford, Oxford, United Kingdom
| | - Jingyuan Xiao
- Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, United States
| | - Zeyan Liew
- Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, United States
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, No. 7, Chung-Shan South Road, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Wan-Ling Tseng
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, United States.
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13
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Suk JW, Poppert Cordts KM, Garvey W, Lerdahl A, Soltis-Vaughan B, Bohn A, Edwards R, Blair RJ, Hwang S, Hwang S. Research Audit on Clinical Utility of Dimensional Disruptive Mood and Behavior Psychopathologies in Child and Adolescent Psychiatry Practice. Front Psychiatry 2022; 13:742148. [PMID: 35463527 PMCID: PMC9020472 DOI: 10.3389/fpsyt.2022.742148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
To investigate the utility of dimensional psychopathologies of disruptive mood and behavior disorders (DBDs) by applying latent profile analysis (LPA) for characterization of youth referred to the tertiary outpatient clinic of child and adolescent psychiatry clinic and pharmacological treatment choices. One hundred fifty-eight children and adolescents with significant DBDs symptoms participated. Core dimensional psychopathologies of DBDs (irritability, callous-unemotional trait, and reactive-proactive aggressive behavior), DSM diagnoses, prescribed medications, and behavioral and emotional problems (Child Behavior Checklist, CBCL) were measured at baseline (clinic intake) and at 3-month follow-up. Latent Profile Analysis (LPA) was applied to characterize the study population based on the levels and interrelations among the core dimensional DBDs psychopathologies. Following LPA, the differences in clinical and treatment features between the latent classes were analyzed. LPA revealed two latent classes based on severity of DBDs symptoms. Class 1 (the moderate group) was characterized by relatively low scores on all trans-diagnostic indicators, whereas class 2 (the severe/critical group) showed higher levels of the dimensional psychopathologies and the majority of CBCL subscales. In addition, the severe/critical group was more often prescribed antipsychotic medications, and also experienced more frequent medication changes (addition, increasing the dose, and trial of different medications). Our findings suggested that application of LPA to a cluster of dimensional DBDs psychopathologies may provide valuable characterization of the youths referred to a tertiary outpatient child and adolescent psychiatric clinic, and offer insight into the providers' decision making on psychotropic medications, by overall severity of these psychopathologies rather than by single categorical diagnosis or single externalizing psychopathology.
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Affiliation(s)
- Ji-Woo Suk
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE, United States
| | | | - William Garvey
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE, United States
| | - Arica Lerdahl
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE, United States
| | | | - Alexandra Bohn
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE, United States
| | - Ryan Edwards
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE, United States
| | - Robert James Blair
- Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Soonjo Hwang
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE, United States
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14
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Cardinale EM, Freitag GF, Brotman MA, Pine DS, Leibenluft E, Kircanski K. Phasic Versus Tonic Irritability: Differential Associations With Attention-Deficit/Hyperactivity Disorder Symptoms. J Am Acad Child Adolesc Psychiatry 2021; 60:1513-1523. [PMID: 33440203 PMCID: PMC9073575 DOI: 10.1016/j.jaac.2020.11.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/18/2020] [Accepted: 01/04/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Irritability is a multifaceted construct in pediatric psychopathology. It has been conceptualized as having a phasic dimension and a tonic dimension. Disruptive mood dysregulation disorder is defined by the presence of both dimensions. Severe irritability, or disruptive mood dysregulation disorder, is highly comorbid with attention-deficit/hyperactivity disorder (ADHD). However, it is unknown whether the presence of ADHD modulates the expression of phasic and tonic irritability. METHOD A data-driven, latent variable approach was used to examine irritability and ADHD symptoms in a transdiagnostic pediatric sample (N = 489) with primary disruptive mood dysregulation disorder, ADHD, subclinical irritability symptoms, or no diagnosis. Using latent profile analyses, we identified 4 classes: high levels of both irritability and ADHD symptoms, high levels of irritability and moderate levels of ADHD symptoms, moderate levels of irritability and high levels of ADHD symptoms, and low levels of both irritability and ADHD symptoms. Confirmatory factor analysis operationalized phasic irritability and tonic irritability. RESULTS As expected, the 2 latent classes characterized by high overall irritability exhibited the highest levels of both phasic and tonic irritability. However, between these 2 high irritability classes, highly comorbid ADHD symptoms were associated with significantly greater phasic irritability than were moderately comorbid ADHD symptoms. In contrast, the 2 high irritability groups did not differ on levels of tonic irritability. CONCLUSION These findings suggest that phasic, but not tonic, irritability has a significant association with ADHD symptoms and that phasic and tonic might be distinct, though highly related, irritability dimensions. Future research should investigate potential mechanisms underlying this differential association.
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15
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Kashihara J, Takebayashi Y, Kunisato Y, Ito M. Classifying patients with depressive and anxiety disorders according to symptom network structures: A Gaussian graphical mixture model-based clustering. PLoS One 2021; 16:e0256902. [PMID: 34469469 PMCID: PMC8409670 DOI: 10.1371/journal.pone.0256902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/17/2021] [Indexed: 11/27/2022] Open
Abstract
Patients with mental disorders often suffer from comorbidity. Transdiagnostic understandings of mental disorders are expected to provide more accurate and detailed descriptions of psychopathology and be helpful in developing efficient treatments. Although conventional clustering techniques, such as latent profile analysis, are useful for the taxonomy of psychopathology, they provide little implications for targeting specific symptoms in each cluster. To overcome these limitations, we introduced Gaussian graphical mixture model (GGMM)-based clustering, a method developed in mathematical statistics to integrate clustering and network statistical approaches. To illustrate the technical details and clinical utility of the analysis, we applied GGMM-based clustering to a Japanese sample of 1,521 patients (Mage = 42.42 years), who had diagnostic labels of major depressive disorder (MDD; n = 406), panic disorder (PD; n = 198), social anxiety disorder (SAD; n = 116), obsessive-compulsive disorder (OCD; n = 66), comorbid MDD and any anxiety disorder (n = 636), or comorbid anxiety disorders (n = 99). As a result, we identified the following four transdiagnostic clusters characterized by i) strong OCD and PD symptoms, and moderate MDD and SAD symptoms; ii) moderate MDD, PD, and SAD symptoms, and weak OCD symptoms; iii) weak symptoms of all four disorders; and iv) strong symptoms of all four disorders. Simultaneously, a covariance symptom network within each cluster was visualized. The discussion highlighted that the GGMM-based clusters help us generate clinical hypotheses for transdiagnostic clusters by enabling further investigations of each symptom network, such as the calculation of centrality indexes.
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Affiliation(s)
- Jun Kashihara
- Department of Social Psychology, Faculty of Sociology, Toyo University, Tokyo, Japan
| | - Yoshitake Takebayashi
- Department of Health Risk Communication, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yoshihiko Kunisato
- Department of Psychology, School of Human Sciences, Senshu University, Kawasaki, Japan
| | - Masaya Ito
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
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16
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Hodgdon EA, Yu Q, Kryza-Lacombe M, Liuzzi MT, Aspe GI, Menacho VC, Bozzetto L, Dougherty L, Wiggins JL. Irritability-related neural responses to frustrative nonreward in adolescents with trauma histories: A preliminary investigation. Dev Psychobiol 2021; 63:e22167. [PMID: 34292612 DOI: 10.1002/dev.22167] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/08/2021] [Accepted: 06/27/2021] [Indexed: 11/08/2022]
Abstract
Irritability, conceptualized as a lowered frustration response threshold to blocked goal attainment (i.e., frustrative nonreward), is a common, detrimental symptom in adolescence. Yet, neural mechanisms of irritability are not well understood. This preliminary study aims to identify irritability-related neural patterns using a novel frustrative nonreward paradigm. Our study used a diverse sample of N = 31 non-White adolescent participants (mean age 14.53 years, SD = 1.74; 83.87% Hispanic/Latinx) to improve generalizability. During fMRI acquisition, participants performed a child-friendly monetary incentive delay task, modified to provide incorrect, negative feedback on performance. Irritability was associated with alterations in amygdala connectivity with basal ganglia, prefrontal, temporal, and parietal regions, and in activation of prefrontal and posterior cortical structures. Across clusters, youths with greater irritability showed activation/connectivity differences between reward blocked versus received conditions in the opposite direction compared to youths with lowered irritability. Alterations in amygdala-temporoparietal connectivity and lingual gyrus activation demonstrated an altered irritability-related recovery effect from the previous trial. These findings support the central role of frustrative nonreward as a key irritability pathway. Our work is one of the first to document neural correlates of difficult recovery from frustration characteristic of irritability and provides insight into novel treatment targets for irritability in diverse populations.
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Affiliation(s)
- Elizabeth A Hodgdon
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Qiongru Yu
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, California, USA
| | - Maria Kryza-Lacombe
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, California, USA
| | - Michael T Liuzzi
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Gabriela Ibarra Aspe
- Department of Psychology, San Diego State University, San Diego, California, USA
| | | | - Lauren Bozzetto
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Lea Dougherty
- Department of Psychology, University of Maryland, College Park, Maryland, USA
| | - Jillian Lee Wiggins
- Department of Psychology, San Diego State University, San Diego, California, USA.,Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, California, USA
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17
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Cardinale EM, Naim R, Haller SP, German R, Botz-Zapp C, Bezek J, Jangraw DC, Brotman MA. Rationale and validation of a novel mobile application probing motor inhibition: Proof of concept of CALM-IT. PLoS One 2021; 16:e0252245. [PMID: 34086728 PMCID: PMC8177631 DOI: 10.1371/journal.pone.0252245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/02/2021] [Indexed: 12/02/2022] Open
Abstract
Identification of behavioral mechanisms underlying psychopathology is essential for the development of novel targeted therapeutics. However, this work relies on rigorous, time-intensive, clinic-based laboratory research, making it difficult to translate research paradigms into tools that can be used by clinicians in the community. The broad adoption of smartphone technology provides a promising opportunity to bridge the gap between the mechanisms identified in the laboratory and the clinical interventions targeting them in the community. The goal of the current study is to develop a developmentally appropriate, engaging, novel mobile application called CALM-IT that probes a narrow biologically informed process, inhibitory control. We aim to leverage the rigorous and robust methods traditionally used in laboratory settings to validate this novel mechanism-driven but easily disseminatable tool that can be used by clinicians to probe inhibitory control in the community. The development of CALM-IT has significant implications for the ability to screen for inhibitory control deficits in the community by both clinicians and researchers. By facilitating assessment of inhibitory control outside of the laboratory setting, researchers could have access to larger and more diverse samples. Additionally, in the clinical setting, CALM-IT represents a novel clinical screening measure that could be used to determine personalized courses of treatment based on the presence of inhibitory control deficits.
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Affiliation(s)
- Elise M. Cardinale
- Emotion & Development Branch, National Institute of Mental Health, Bethesda, MD, United States of America
| | - Reut Naim
- Emotion & Development Branch, National Institute of Mental Health, Bethesda, MD, United States of America
| | - Simone P. Haller
- Emotion & Development Branch, National Institute of Mental Health, Bethesda, MD, United States of America
| | - Ramaris German
- Emotion & Development Branch, National Institute of Mental Health, Bethesda, MD, United States of America
| | - Christian Botz-Zapp
- Emotion & Development Branch, National Institute of Mental Health, Bethesda, MD, United States of America
| | - Jessica Bezek
- Emotion & Development Branch, National Institute of Mental Health, Bethesda, MD, United States of America
| | - David C. Jangraw
- Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, VT, United States of America
| | - Melissa A. Brotman
- Emotion & Development Branch, National Institute of Mental Health, Bethesda, MD, United States of America
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18
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Mimouni-Bloch A, Offek H, Engel-Yeger B, Rosenblum S, Posener E, Silman Z, Tauman R. Association between sensory modulation and sleep difficulties in children with Attention Deficit Hyperactivity Disorder (ADHD). Sleep Med 2021; 84:107-113. [PMID: 34144449 DOI: 10.1016/j.sleep.2021.05.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Sleep difficulties have been reported in up to 85% of children with Attention Deficit hyperactivity disorder (ADHD). Children with ADHD exhibit commonly sensory modulation difficulties (SMD) and experience more significant functional difficulties. Sleep difficulties have also been associated with SMD. The aim of this study was to evaluate whether SMD are associated with sleep difficulties in children with ADHD. METHODS We assessed sleep difficulties using the Children's Sleep Habits Questionnaire, and SMD using the Short Sensory Profile (SSP) questionnaire. A total of 25 children with ADHD and atypical sensory profiles, 13 children with ADHD and typical sensory profiles and 38 children used as controls (all children aged 8-11 years) were included. RESULTS Sleep difficulties were detected in 86.4% of children with ADHD and atypical SSPs, as compared to 30.8% of children with ADHD and typical SSPs, and 16.7% of controls. A multivariate logistic regression revealed that children with ADHD and atypical SSPs had significantly increased odds for sleep difficulties as compared to controls (OR = 32.4; 95% CI 4.0-260.1, p = 0.001), while children with ADHD and typical SSPs were indistinguishable from controls. Suspected confounders (gender, age, mother's education, and stimulant therapy) did not contribute to sleep difficulties. CONCLUSION In this pilot study, SMD were associated with sleep difficulties in children with ADHD.
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Affiliation(s)
- Aviva Mimouni-Bloch
- The Pediatric Neurology and Developmental Unit, Loewenstein Rehabilitation Medical Center, Raanana, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Hagar Offek
- The Pediatric Neurology and Developmental Unit, Loewenstein Rehabilitation Medical Center, Raanana, Israel; The Child Development Center of Clalit Health Services, Natanya, Israel; Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences of the Haifa University, Haifa, Israel
| | - Batya Engel-Yeger
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences of the Haifa University, Haifa, Israel
| | - Sara Rosenblum
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences of the Haifa University, Haifa, Israel
| | - Edith Posener
- The Child Development Center of Clalit Health Services, Natanya, Israel
| | - Zmira Silman
- The Pediatric Neurology and Developmental Unit, Loewenstein Rehabilitation Medical Center, Raanana, Israel
| | - Riva Tauman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Sleep Disorders Center, Tel-Aviv Medical Center, Israel
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19
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Haller SP, Stoddard J, Pagliaccio D, Bui H, MacGillivray C, Jones M, Brotman MA. Computational Modeling of Attentional Impairments in Disruptive Mood Dysregulation and Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry 2021; 60:637-645. [PMID: 33242544 PMCID: PMC8096646 DOI: 10.1016/j.jaac.2020.08.468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/04/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Computational models provide information about cognitive components underlying behavior. When applied to psychopathology-relevant processes, they offer additional insight to observed differences in behavioral performance. Drift diffusion models have been successfully applied to investigate processing efficiency during binary choice tasks. Using these models, we examine the association between psychopathology (irritability and inattention/hyperactivity) and processing efficiency under different attentional demands. METHOD A total of 187 youths with attention-deficit/hyperactivity disorder (ADHD), disruptive mood dysregulation disorder (DMDD), both disorders, or no major psychopathology (age, mean ± SD, 13.09 ± 2.55 y, 34% female) completed an Eriksen Flanker task. Of these, 87 youths provided complete data on dimensional measures of the core symptom of DMDD (irritability) and those of ADHD (inattention and hyperactivity). RESULTS In a categorical diagnosis-based analysis (n = 187), we found significant interactive effects among ADHD, DMDD, and task condition on processing efficiency, whereby changes in processing efficiency between conflict and nonconflict conditions were larger in youths without psychopathology compared with patients. Analysis of symptom severity (n = 87) across diagnoses similarly revealed an interaction between symptom dimensions and task condition on processing efficiency. Irritability moderated the magnitude of association between inattention symptoms and difference in processing efficiency between conflict and nonconflict conditions. CONCLUSION Adapting processing efficiency to cognitive demands may represent a shared cognitive endophenotype for both ADHD and DMDD. Highly irritable and/or inattentive youth may have difficulty adjusting processing efficiency to changing task demands, possibly reflecting impairments in cognitive flexibility.
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Affiliation(s)
| | - Joel Stoddard
- University of Colorado, Aurora.; University of Colorado, Colorado
| | - David Pagliaccio
- New York State Psychiatric Institute, Columbia University, New York
| | - Hong Bui
- National Institute of Mental Health, Bethesda, Maryland
| | | | - Matt Jones
- University of Colorado Boulder.; University of Colorado, Colorado
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20
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Elvin OM, Modecki KL, Finch J, Donnolley K, Farrell LJ, Waters AM. Joining the pieces in childhood irritability: Distinct typologies predict conduct, depressive, and anxiety symptoms. Behav Res Ther 2020; 136:103779. [PMID: 33291055 DOI: 10.1016/j.brat.2020.103779] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/15/2020] [Accepted: 11/17/2020] [Indexed: 11/26/2022]
Abstract
This study utilised a person-centered approach to understand childhood irritability as a transdiagnostic feature of psychopathology. Latent profile analysis was employed within a community sample (n = 93) of 9-11 year olds to identify typologies of self-regulation capabilities, positive wellbeing characteristics of hope and flourishing, and social functioning that cluster with children's irritability to mitigate risk for psychopathology symptoms. Three distinct profiles of youth were derived, High Irritability/Low Self-Regulation of Negative Emotion (9%), Moderate Irritability/Low Behavioural Control (34%) and Low Irritability/High Positive Wellbeing Characteristics (57%). Profiles were empirically validated and differentially related to symptoms of anxiety, depression and conduct problems. Notably, High Irritability/Low Self-Regulation of Negative Emotion children were characterised by the highest levels of irritability and peer problems and the lowest self-regulation of negative emotion, prosocial behaviours, hope and flourishing relative to children within the other profiles, pointing to the potential utility of future targeted, transdiagnostic interventions. Within our community-based sample, a protective profile of Low Irritability/High Positive Wellbeing Characteristics children were also described by the lowest levels of irritability and peer problems and the highest positive and negative emotion self-regulation, behavioural control, prosocial behaviours, hope and flourishing. Findings demonstrate that different levels of irritability severity cluster with different self-regulation capabilities and wellbeing characteristics and predict risk for different types of psychopathology. Targeted interventions should seek to address children's irritability alongside self-regulation and positive wellbeing characteristics to further mitigate risks of psychopathology and associated problems.
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Affiliation(s)
- Olivia M Elvin
- School of Applied Psychology, Griffith University, Mount Gravatt Campus, 176 Messines Ridge Road, Mount Gravatt, QLD, 4122, Australia.
| | - Kathryn L Modecki
- School of Applied Psychology, Griffith University, Mount Gravatt Campus, 176 Messines Ridge Road, Mount Gravatt, QLD, 4122, Australia; Menzies Health Institute Queensland, Australia.
| | - Jules Finch
- School of Applied Psychology, Griffith University, Southport Campus, 1 Parklands Drive, Southport, QLD, 4215, Australia
| | | | - Lara J Farrell
- School of Applied Psychology, Griffith University, Southport Campus, 1 Parklands Drive, Southport, QLD, 4215, Australia
| | - Allison M Waters
- School of Applied Psychology, Griffith University, Mount Gravatt Campus, 176 Messines Ridge Road, Mount Gravatt, QLD, 4122, Australia.
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21
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Jiang T, Gradus JL, Rosellini AJ. Supervised Machine Learning: A Brief Primer. Behav Ther 2020; 51:675-687. [PMID: 32800297 PMCID: PMC7431677 DOI: 10.1016/j.beth.2020.05.002] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 12/23/2022]
Abstract
Machine learning is increasingly used in mental health research and has the potential to advance our understanding of how to characterize, predict, and treat mental disorders and associated adverse health outcomes (e.g., suicidal behavior). Machine learning offers new tools to overcome challenges for which traditional statistical methods are not well-suited. This paper provides an overview of machine learning with a specific focus on supervised learning (i.e., methods that are designed to predict or classify an outcome of interest). Several common supervised learning methods are described, along with applied examples from the published literature. We also provide an overview of supervised learning model building, validation, and performance evaluation. Finally, challenges in creating robust and generalizable machine learning algorithms are discussed.
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Affiliation(s)
| | - Jaimie L Gradus
- Boston University School of Public Health; Boston University School of Medicine
| | - Anthony J Rosellini
- Center for Anxiety and Related Disorders, Boston University; Department of Psychological and Brain Sciences, Boston University.
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22
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Filippi CA, Subar AR, Sachs JF, Kircanski K, Buzzell G, Pagliaccio D, Abend R, Fox NA, Leibenluft E, Pine DS. Developmental pathways to social anxiety and irritability: The role of the ERN. Dev Psychopathol 2020; 32:897-907. [PMID: 31656217 PMCID: PMC7265174 DOI: 10.1017/s0954579419001329] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Early behaviors that differentiate later biomarkers for psychopathology can guide preventive efforts while also facilitating pathophysiological research. We tested whether error-related negativity (ERN) moderates the link between early behavior and later psychopathology in two early childhood phenotypes: behavioral inhibition and irritability. From ages 2 to 7 years, children (n = 291) were assessed longitudinally for behavioral inhibition (BI) and irritability. Behavioral inhibition was assessed via maternal report and behavioral responses to novelty. Childhood irritability was assessed using the Child Behavior Checklist. At age 12, an electroencephalogram (EEG) was recorded while children performed a flanker task to measure ERN, a neural indicator of error monitoring. Clinical assessments of anxiety and irritability were conducted using questionnaires (i.e., Screen for Child Anxiety Related Disorders and Affective Reactivity Index) and clinical interviews. Error monitoring interacted with early BI and early irritability to predict later psychopathology. Among children with high BI, an enhanced ERN predicted greater social anxiety at age 12. In contrast, children with high childhood irritability and blunted ERN predicted greater irritability at age 12. This converges with previous work and provides novel insight into the specificity of pathways associated with psychopathology.
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Affiliation(s)
- Courtney A Filippi
- Section on Development and Affective Neuroscience, National Institute of Mental Health, Bethesda, MD20892, USA
| | - Anni R Subar
- Section on Development and Affective Neuroscience, National Institute of Mental Health, Bethesda, MD20892, USA
| | - Jessica F Sachs
- Section on Development and Affective Neuroscience, National Institute of Mental Health, Bethesda, MD20892, USA
| | - Katharina Kircanski
- Section on Development and Affective Neuroscience, National Institute of Mental Health, Bethesda, MD20892, USA
| | - George Buzzell
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD20742, USA
| | - David Pagliaccio
- Division of Child & Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY10032, USA
| | - Rany Abend
- Section on Development and Affective Neuroscience, National Institute of Mental Health, Bethesda, MD20892, USA
| | - Nathan A Fox
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD20742, USA
| | - Ellen Leibenluft
- Section on Development and Affective Neuroscience, National Institute of Mental Health, Bethesda, MD20892, USA
| | - Daniel S Pine
- Section on Development and Affective Neuroscience, National Institute of Mental Health, Bethesda, MD20892, USA
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23
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Divergence in cortical representations of threat generalization in affective versus perceptual circuitry in childhood: Relations with anxiety. Neuropsychologia 2020; 142:107416. [PMID: 32173623 DOI: 10.1016/j.neuropsychologia.2020.107416] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/22/2020] [Accepted: 02/29/2020] [Indexed: 01/16/2023]
Abstract
Children at risk for anxiety display elevated threat sensitivity and may inaccurately classify safe stimuli as threatening, a process known as overgeneralization. Little is known about whether such overgeneralization might stem from altered sensory representations of stimuli resembling threat, especially in youth. Here we implement representational similarity analysis of fMRI data to examine the similarity of neural representations of threat versus ambiguous or safe stimuli in threat and perceptual neurocircuitry among children at varying levels of anxiety traits. Three weeks after completing threat conditioning and extinction, children underwent an fMRI extinction recall task, during which they viewed the extinguished threat cue (CS+), safety cue (CS-) and generalization stimuli (GS) consisting of CS-/CS+ blends. Multivoxel BOLD signal patterns were measured in seven regions of interest: four affective areas (ventromedial prefrontal cortex (vmPFC), anterior insular cortex (AIC), dorsomedial prefrontal cortex (dmPFC), and amygdala) and three perceptual areas (inferior temporal cortex (ITC) and visual areas V1 and V4). Compared to low anxious children, children with high trait anxiety evidenced less neural pattern differentiation between the CS+ and similar GS, particularly in the vmPFC. Together, these results demonstrate the utility of multivariate neuroimaging approaches in arbitrating the relative contributions of perceptual versus affective sources to threat generalization.
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24
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Seymour KE, Rosch KS, Tiedemann A, Mostofsky SH. The Validity of a Frustration Paradigm to Assess the Effect of Frustration on Cognitive Control in School-Age Children. Behav Ther 2020; 51:268-282. [PMID: 32138937 PMCID: PMC7523008 DOI: 10.1016/j.beth.2019.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 02/03/2023]
Abstract
Irritability refers to a proneness for anger, and is a symptom of internalizing and externalizing psychopathology. Since irritability is associated with significant cross-sectional and longitudinal impairments, research on the behavioral and neural correlates of pediatric irritability in populations at risk for significant irritability is of paramount importance. Irritability can be assessed in the laboratory using behavioral paradigms that elicit frustration. Few behavioral frustration paradigms have been designed to measure the effects of frustration on cognitive control. Therefore, the goal of the present study was to validate a behavioral frustration paradigm for use in school-age children which addressed some of the limitations of prior research. Participants included children, ages 8-12 years, who were either typically developing (TD; n = 38) or diagnosed with attention-deficit/hyperactivity disorder (ADHD; n = 67), which provided a sample of children with a range of baseline irritability. All participants completed the Frustration Go/No-Go (GNG) task, and self-reported irritability was assessed using the Affective Reactivity Index. Results showed that across participants, self-reported frustration, commission error rate, and tau all increased with the addition of frustration, with similar effect sizes in ADHD and TD groups. Further, self-reported irritability, moreso than ADHD symptoms, predicted changes in self-reported frustration during the task. Together, these results support the construct validity of the Frustration GNG task as a means of assessing the effect of frustration on cognitive control. Clinical applications and future directions are discussed.
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Affiliation(s)
- Karen E. Seymour
- Johns Hopkins University School of Medicine, Johns Hopkins University Bloomberg School of Public Health, Kennedy Krieger Institute
| | - Keri S. Rosch
- Johns Hopkins University School of Medicine, Kennedy Krieger Institute
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25
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Development and Application of an Innovative Transdiagnostic Treatment Approach for Pediatric Irritability. Behav Ther 2020; 51:334-349. [PMID: 32138942 DOI: 10.1016/j.beth.2019.07.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 07/02/2019] [Accepted: 07/12/2019] [Indexed: 02/07/2023]
Abstract
Recent work has drawn attention to the previously underrecognized role that irritability plays in childhood psychopathology. Despite increased recognition of the clinical importance of pediatric irritability as a transdiagnostic symptom dimension, there is a lack of evidence-based treatments for this population that simultaneously and equitably addresses both child and contextual (e.g., parental) factors implicated in the development and maintenance of associated emotional and behavioral difficulties. In the current pilot study, we adapted the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C) for the treatment of pediatric irritability in a sample of 19 children (ages 8 to 12) with primary presenting concerns of irritability and/or disruptive behaviors. Results supported the feasibility and acceptability of this treatment and provided preliminary evidence that such an approach may yield improved outcomes for symptoms of pediatric irritability and disruptive behaviors. Implications of these findings for future research and clinical interventions for pediatric irritability are discussed.
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26
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Linke J, Kircanski K, Brooks J, Perhamus G, Gold AL, Brotman MA. Exposure-Based Cognitive-Behavioral Therapy for Disruptive Mood Dysregulation Disorder: An Evidence-Based Case Study. Behav Ther 2020; 51:320-333. [PMID: 32138941 PMCID: PMC9719109 DOI: 10.1016/j.beth.2019.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/13/2019] [Accepted: 05/10/2019] [Indexed: 10/26/2022]
Abstract
Severe, chronic irritability is one of the most frequently reported problems in youth referred for psychiatric care. Irritability predicts adult depressive and anxiety disorders, and long-term impairment. Reflecting this pressing public health need, severe, chronic, and impairing irritability is now codified by the DSM-5 diagnosis of disruptive mood dysregulation disorder (DMDD). Since DMDD has only recently been added as its own nosological class, efficacious treatments that specifically target severe irritability as it presents in DMDD are still being developed. In a recent pilot study, we described the general concept of exposure-based cognitive-behavioral therapy (CBT) for irritability. This mechanism-driven treatment is based on our pathophysiological model of irritability that postulates two underlying mechanisms, which potentiate each other: (1) heightened reactivity to frustrative nonreward, and (2) aberrant approach responses to threat. In this case report, we describe and illustrate the specific therapeutic techniques used to address severe irritability in an 11-year-old boy with a primary diagnosis of DMDD. Specific techniques within this CBT include motivational interviewing to build commitment and target oppositionality; creation of an anger hierarchy; in-session controlled, gradual exposure; and parent training focusing on contingency management to counteract the instrumental learning deficits in irritable youth. Parents learn to tolerate their own emotional responses to their youth's irritability (e.g., parents engage in their own exposure) and increase their adaptive contingencies for their youth's behavior (e.g., withdraw attention during unwanted behavior, praise desirable behavior). Future directions in the context of this CBT, such as leveraging technology, computational modeling, and pathophysiological targets, are discussed.
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Affiliation(s)
- Julia Linke
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health.
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health
| | - Julia Brooks
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health
| | - Gretchen Perhamus
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health
| | | | - Melissa A. Brotman
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health
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27
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Loring DW, Meador KJ, Shinnar S, Gaillard WD, Wheless JW, Kessler SK, Conry JA, Berl MM, Burns TG, Glauser TA, Kinkead B, Cnaan A. Differential antiseizure medication sensitivity of the Affective Reactivity Index: A randomized controlled trial in new-onset pediatric focal epilepsy. Epilepsy Behav 2020; 102:106687. [PMID: 31816478 PMCID: PMC7232830 DOI: 10.1016/j.yebeh.2019.106687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/04/2019] [Accepted: 11/04/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Irritability is a adverse effect of many antiseizure medications (ASMs), but there are no validated measures currently available to characterize this behavioral risk. We examined both child and parent/guardian versions of the Affective Reactivity Index (ARI), a validated measure developed for application in adolescent psychiatry, to determine its sensitivity to ASM-related irritability. We hypothesized irritability increases associated with levetiracetam (LEV) but not lamotrigine (LTG) or oxcarbazepine (OXC). METHOD The ARI was administered to 71 child and parent/guardian pairs randomized to one of three common ASMs (LEV, LTG, OXC) used to treat new-onset focal (localization-related) epilepsy. Subjects were recruited as part of a prospective multicenter, randomized, open-label, parallel group design. The ARI was administered at baseline prior to treatment initiation and again at 3 months after ASM initiation. RESULTS There was a significant increase in ARI ratings for both child and parent/guardian ratings for LEV but not LTG or OXC when assessed 3 months after treatment initiation. When examined on the individual subject level using a criterion of at least a 3-point ARI increase, there was an increase associated with LEV for child ratings but not parent/guardian scores. CONCLUSION Both child and parent/guardian versions of the ARI appear sensitive to medication-induced irritability associated with LEV on both the group and individual levels. The findings extend the applicability of ARI from characterizing the presence of clinical irritability as a psychiatric diagnostic feature to a more modifiable aspect of behavior change related to medication management and support its use in clinical trial applications.
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Affiliation(s)
- David W. Loring
- Departments of Neurology and Pediatrics, Emory University,
Atlanta, GA, United States of America,Corresponding author at: Emory University Brain
Health Center, 12 Executive Park, Atlanta, GA 30329, United States of America.
(D.W. Loring)
| | - Kimford J. Meador
- Department of Neurology & Neurological Sciences,
Stanford University, Palo Alto, CA, United States of America
| | - Shlomo Shinnar
- Departments of Neurology, Pediatrics, Epidemiology &
Population Health, Montefiore Medical Center, Albert Einstein College of Medicine,
Bronx, NY, United States of America
| | - William Davis Gaillard
- Department of Neurology, Children’s National Health
System, Washington, DC, United States of America
| | - James W. Wheless
- Department of Pediatrics, Division of Neurology, University
of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis,
TN, United States of America
| | - Sudha K. Kessler
- Division of Neurology, Children’s Hospital of
Philadelphia, Departments of Neurology and Pediatrics, University of Pennsylvania,
Philadelphia, PA, United States of America
| | - Joan A. Conry
- Department of Neurology, Children’s National Health
System, Washington, DC, United States of America
| | - Madison M. Berl
- Department of Neuropsychology, Children’s National
Health System, Washington, DC, United States of America
| | - Thomas G. Burns
- Department of Neuropsychology, Children’s Healthcare
of Atlanta, Atlanta, GA, United States of America
| | - Tracy A. Glauser
- Division of Neurology, Cincinnati Children’s
Hospital Medical Center and Department of Pediatrics, University of Cincinnati
College of Medicine, Cincinnati, OH, United States of America
| | - Becky Kinkead
- Department of Psychiatry and Behavioral Science, Emory
University, Atlanta, GA, United States of America
| | - Avital Cnaan
- Department of Pediatrics, George Washington University,
Washington, DC, United States of America
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28
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Ricketts EJ, Snorrason I, Kircanski K, Alexander JR, Stiede JT, Thamrin H, Flessner CA, Franklin ME, Keuthen NJ, Walther MR, Piacentini J, Stein DJ, Woods DW. A latent profile analysis of age of onset in trichotillomania. Ann Clin Psychiatry 2019; 31:169-178. [PMID: 31369656 PMCID: PMC9528732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Trichotillomania (TTM) onset may occur across the lifespan; however, adolescent onset is most frequently reported. Several studies have explored clinical differences between TTM age-of-onset groups with mixed results. We investigated empirically defined age-of-onset groups in adults with TTM, and clinical differences between groups. METHODS Participants included 1,604 adult respondents to an internet survey who endorsed DSM-IV-TR TTM criteria. Latent profile analysis was performed to identify TTM age-of-onset subgroups, which were then compared on demographic and clinical features. RESULTS The most optimal model was a 2-class solution comprised of a large group with average TTM onset during adolescence (n = 1,539; 95.9% of the sample; mean age of onset = 12.4) and a small group with average onset in middle adulthood (n = 65; 4.1% of the sample; mean age of onset = 35.6). The late-onset group differed from the early-onset group on several clinical variables (eg, less likely to report co-occurring bodyfocused repetitive behaviors). CONCLUSIONS Findings suggest the presence of at least 2 distinct TTM age-of-onset subgroups: an early-onset group with onset during adolescence, and a late-onset group with onset in middle adulthood. Future research is needed to further validate these subgroups and explore their clinical utility.
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Affiliation(s)
- Emily J Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90024-5055 USA. E-MAIL:
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29
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Evans SC, Bonadio FT, Bearman SK, Ugueto AM, Chorpita BF, Weisz JR. Assessing the Irritable and Defiant Dimensions of Youth Oppositional Behavior Using CBCL and YSR Items. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 49:804-819. [PMID: 31276433 DOI: 10.1080/15374416.2019.1622119] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Research suggests that irritability and defiance are distinct dimensions of youth oppositionality that are differentially associated with internalizing and conduct problems, respectively. Because much of this evidence has emerged with limited psychometric evaluation, we conducted the first multi-informant examination of selected Child Behavior Checklist (CBCL) and Youth Self Report (YSR) items for measuring irritability and defiance in a large clinical sample. Clinically referred youths (N = 1,030; ages 6-15; 43% female, 42% ethnic minority) were assessed prior to treatment using multi-informant rating scales and diagnostic interviews. Analyses examined factor structure, invariance, internal consistency, multi-informant patterns, and convergent, discriminant, and criterion validity with internalizing and externalizing problems/disorders. A correlated 2-factor model of irritability (stubborn/sullen/irritable, mood, temper) and defiance (argues, disobeys-home, disobeys-school) fit well for both informants. Adequate measurement invariance and scale consistency was consistently found for parent-report but not youth-report. With both informants, all hypothesized convergent and discriminant validity associations were supported: irritability and defiance with internalizing and conduct scales, respectively. However, hypothesized criterion validity associations were largely found only by parent-report: irritability with anxiety and depressive disorders, defiance with conduct disorder, and both with oppositional defiant disorder. Results consistently supported the reliability and validity of the CBCL irritability and defiance scales, with somewhat less consistent support for the YSR scales. Thus, CBCL items may provide psychometrically sound assessment of irritability and defiance, whereas further research is needed to advance youth-report and multi-informant strategies. Results also provide further support for a two subdimension model of oppositional defiant disorder symptoms that includes irritability and defiance.
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Affiliation(s)
| | - F Tony Bonadio
- Department of Psychology, Harvard University.,Institute for Innovation and Implementation, School of Social Work , University of Maryland, Baltimore
| | | | - Ana M Ugueto
- Department of Psychiatry, McGovern Medical School, UT Health Science Center at Houston
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30
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Tseng WL, Deveney CM, Stoddard J, Kircanski K, Frackman AE, Yi JY, Hsu D, Moroney E, Machlin L, Donahue L, Roule A, Perhamus G, Reynolds RC, Roberson-Nay R, Hettema JM, Towbin KE, Stringaris A, Pine DS, Brotman MA, Leibenluft E. Brain Mechanisms of Attention Orienting Following Frustration: Associations With Irritability and Age in Youths. Am J Psychiatry 2019; 176:67-76. [PMID: 30336704 PMCID: PMC6408218 DOI: 10.1176/appi.ajp.2018.18040491] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Childhood irritability is a common, impairing problem with changing age-related manifestations that predict long-term adverse outcomes. However, more investigation of overall and age-specific neural correlates is needed. Because youths with irritability exhibit exaggerated responses to frustrating stimuli, the authors used a frustration functional MRI (fMRI) paradigm to examine associations between irritability and neural activation and tested the moderating effect of age. METHOD The authors studied a transdiagnostic sample of 195 youths with varying levels of irritability (disruptive mood dysregulation disorder, N=52; anxiety disorder, N=42; attention deficit hyperactivity disorder, N=40; and healthy volunteers, N=61). Irritability was measured by parent and child reports on the Affective Reactivity Index. The fMRI paradigm was a cued-attention task differentiating neural activity in response to frustration (rigged feedback) from activity during attention orienting in the trial following frustration. RESULTS Whole-brain activation analyses revealed associations with irritability during attention orienting following frustration. Irritability was positively associated with frontal-striatal activation, specifically in the dorsolateral prefrontal cortex, inferior frontal gyrus, and caudate. Age moderated the association between irritability and activation in some frontal and posterior regions (the anterior cingulate cortex, medial frontal gyrus, cuneus, precuneus, and superior parietal lobule [F=19.04-28.51, df=1, 189, partial eta squared=0.09-0.13]). Specifically, higher irritability was more strongly related to increased activation in younger youths compared with older youths. CONCLUSIONS Following frustration, levels of irritability correlated with activity in neural systems mediating attention orienting, top-down regulation of emotions, and motor execution. Although most associations were independent of age, dysfunction in the anterior cingulate cortex and posterior regions was more pronounced in young children with irritability.
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Affiliation(s)
- Wan-Ling Tseng
- From the Department of Health and Human Services, Emotion and Development Branch and Scientific and Statistical Computing Core, NIMH, Bethesda, Md.; the Department of Psychiatry and the Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; the Department of Psychology, Wellesley College, Wellesley, Mass.; the University of Colorado School of Medicine, Aurora, Colo.; the Department of Medicine, Stanford University, Stanford, Calif.; the Departments of Psychology and Neuroscience, University of North Carolina at Chapel Hill; Emory University School of Medicine, Atlanta; the Department of Psychology, University of California at Los Angeles; and University of Michigan Medical School, Ann Arbor
| | - Christen M Deveney
- From the Department of Health and Human Services, Emotion and Development Branch and Scientific and Statistical Computing Core, NIMH, Bethesda, Md.; the Department of Psychiatry and the Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; the Department of Psychology, Wellesley College, Wellesley, Mass.; the University of Colorado School of Medicine, Aurora, Colo.; the Department of Medicine, Stanford University, Stanford, Calif.; the Departments of Psychology and Neuroscience, University of North Carolina at Chapel Hill; Emory University School of Medicine, Atlanta; the Department of Psychology, University of California at Los Angeles; and University of Michigan Medical School, Ann Arbor
| | - Joel Stoddard
- From the Department of Health and Human Services, Emotion and Development Branch and Scientific and Statistical Computing Core, NIMH, Bethesda, Md.; the Department of Psychiatry and the Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; the Department of Psychology, Wellesley College, Wellesley, Mass.; the University of Colorado School of Medicine, Aurora, Colo.; the Department of Medicine, Stanford University, Stanford, Calif.; the Departments of Psychology and Neuroscience, University of North Carolina at Chapel Hill; Emory University School of Medicine, Atlanta; the Department of Psychology, University of California at Los Angeles; and University of Michigan Medical School, Ann Arbor
| | - Katharina Kircanski
- From the Department of Health and Human Services, Emotion and Development Branch and Scientific and Statistical Computing Core, NIMH, Bethesda, Md.; the Department of Psychiatry and the Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; the Department of Psychology, Wellesley College, Wellesley, Mass.; the University of Colorado School of Medicine, Aurora, Colo.; the Department of Medicine, Stanford University, Stanford, Calif.; the Departments of Psychology and Neuroscience, University of North Carolina at Chapel Hill; Emory University School of Medicine, Atlanta; the Department of Psychology, University of California at Los Angeles; and University of Michigan Medical School, Ann Arbor
| | - Anna E Frackman
- From the Department of Health and Human Services, Emotion and Development Branch and Scientific and Statistical Computing Core, NIMH, Bethesda, Md.; the Department of Psychiatry and the Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; the Department of Psychology, Wellesley College, Wellesley, Mass.; the University of Colorado School of Medicine, Aurora, Colo.; the Department of Medicine, Stanford University, Stanford, Calif.; the Departments of Psychology and Neuroscience, University of North Carolina at Chapel Hill; Emory University School of Medicine, Atlanta; the Department of Psychology, University of California at Los Angeles; and University of Michigan Medical School, Ann Arbor
| | - Jennifer Y Yi
- From the Department of Health and Human Services, Emotion and Development Branch and Scientific and Statistical Computing Core, NIMH, Bethesda, Md.; the Department of Psychiatry and the Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; the Department of Psychology, Wellesley College, Wellesley, Mass.; the University of Colorado School of Medicine, Aurora, Colo.; the Department of Medicine, Stanford University, Stanford, Calif.; the Departments of Psychology and Neuroscience, University of North Carolina at Chapel Hill; Emory University School of Medicine, Atlanta; the Department of Psychology, University of California at Los Angeles; and University of Michigan Medical School, Ann Arbor
| | - Derek Hsu
- From the Department of Health and Human Services, Emotion and Development Branch and Scientific and Statistical Computing Core, NIMH, Bethesda, Md.; the Department of Psychiatry and the Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; the Department of Psychology, Wellesley College, Wellesley, Mass.; the University of Colorado School of Medicine, Aurora, Colo.; the Department of Medicine, Stanford University, Stanford, Calif.; the Departments of Psychology and Neuroscience, University of North Carolina at Chapel Hill; Emory University School of Medicine, Atlanta; the Department of Psychology, University of California at Los Angeles; and University of Michigan Medical School, Ann Arbor
| | - Elizabeth Moroney
- From the Department of Health and Human Services, Emotion and Development Branch and Scientific and Statistical Computing Core, NIMH, Bethesda, Md.; the Department of Psychiatry and the Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; the Department of Psychology, Wellesley College, Wellesley, Mass.; the University of Colorado School of Medicine, Aurora, Colo.; the Department of Medicine, Stanford University, Stanford, Calif.; the Departments of Psychology and Neuroscience, University of North Carolina at Chapel Hill; Emory University School of Medicine, Atlanta; the Department of Psychology, University of California at Los Angeles; and University of Michigan Medical School, Ann Arbor
| | - Laura Machlin
- From the Department of Health and Human Services, Emotion and Development Branch and Scientific and Statistical Computing Core, NIMH, Bethesda, Md.; the Department of Psychiatry and the Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; the Department of Psychology, Wellesley College, Wellesley, Mass.; the University of Colorado School of Medicine, Aurora, Colo.; the Department of Medicine, Stanford University, Stanford, Calif.; the Departments of Psychology and Neuroscience, University of North Carolina at Chapel Hill; Emory University School of Medicine, Atlanta; the Department of Psychology, University of California at Los Angeles; and University of Michigan Medical School, Ann Arbor
| | - Laura Donahue
- From the Department of Health and Human Services, Emotion and Development Branch and Scientific and Statistical Computing Core, NIMH, Bethesda, Md.; the Department of Psychiatry and the Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; the Department of Psychology, Wellesley College, Wellesley, Mass.; the University of Colorado School of Medicine, Aurora, Colo.; the Department of Medicine, Stanford University, Stanford, Calif.; the Departments of Psychology and Neuroscience, University of North Carolina at Chapel Hill; Emory University School of Medicine, Atlanta; the Department of Psychology, University of California at Los Angeles; and University of Michigan Medical School, Ann Arbor
| | - Alexandra Roule
- From the Department of Health and Human Services, Emotion and Development Branch and Scientific and Statistical Computing Core, NIMH, Bethesda, Md.; the Department of Psychiatry and the Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; the Department of Psychology, Wellesley College, Wellesley, Mass.; the University of Colorado School of Medicine, Aurora, Colo.; the Department of Medicine, Stanford University, Stanford, Calif.; the Departments of Psychology and Neuroscience, University of North Carolina at Chapel Hill; Emory University School of Medicine, Atlanta; the Department of Psychology, University of California at Los Angeles; and University of Michigan Medical School, Ann Arbor
| | - Gretchen Perhamus
- From the Department of Health and Human Services, Emotion and Development Branch and Scientific and Statistical Computing Core, NIMH, Bethesda, Md.; the Department of Psychiatry and the Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; the Department of Psychology, Wellesley College, Wellesley, Mass.; the University of Colorado School of Medicine, Aurora, Colo.; the Department of Medicine, Stanford University, Stanford, Calif.; the Departments of Psychology and Neuroscience, University of North Carolina at Chapel Hill; Emory University School of Medicine, Atlanta; the Department of Psychology, University of California at Los Angeles; and University of Michigan Medical School, Ann Arbor
| | - Richard C Reynolds
- From the Department of Health and Human Services, Emotion and Development Branch and Scientific and Statistical Computing Core, NIMH, Bethesda, Md.; the Department of Psychiatry and the Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; the Department of Psychology, Wellesley College, Wellesley, Mass.; the University of Colorado School of Medicine, Aurora, Colo.; the Department of Medicine, Stanford University, Stanford, Calif.; the Departments of Psychology and Neuroscience, University of North Carolina at Chapel Hill; Emory University School of Medicine, Atlanta; the Department of Psychology, University of California at Los Angeles; and University of Michigan Medical School, Ann Arbor
| | - Roxann Roberson-Nay
- From the Department of Health and Human Services, Emotion and Development Branch and Scientific and Statistical Computing Core, NIMH, Bethesda, Md.; the Department of Psychiatry and the Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; the Department of Psychology, Wellesley College, Wellesley, Mass.; the University of Colorado School of Medicine, Aurora, Colo.; the Department of Medicine, Stanford University, Stanford, Calif.; the Departments of Psychology and Neuroscience, University of North Carolina at Chapel Hill; Emory University School of Medicine, Atlanta; the Department of Psychology, University of California at Los Angeles; and University of Michigan Medical School, Ann Arbor
| | - John M Hettema
- From the Department of Health and Human Services, Emotion and Development Branch and Scientific and Statistical Computing Core, NIMH, Bethesda, Md.; the Department of Psychiatry and the Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; the Department of Psychology, Wellesley College, Wellesley, Mass.; the University of Colorado School of Medicine, Aurora, Colo.; the Department of Medicine, Stanford University, Stanford, Calif.; the Departments of Psychology and Neuroscience, University of North Carolina at Chapel Hill; Emory University School of Medicine, Atlanta; the Department of Psychology, University of California at Los Angeles; and University of Michigan Medical School, Ann Arbor
| | - Kenneth E Towbin
- From the Department of Health and Human Services, Emotion and Development Branch and Scientific and Statistical Computing Core, NIMH, Bethesda, Md.; the Department of Psychiatry and the Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; the Department of Psychology, Wellesley College, Wellesley, Mass.; the University of Colorado School of Medicine, Aurora, Colo.; the Department of Medicine, Stanford University, Stanford, Calif.; the Departments of Psychology and Neuroscience, University of North Carolina at Chapel Hill; Emory University School of Medicine, Atlanta; the Department of Psychology, University of California at Los Angeles; and University of Michigan Medical School, Ann Arbor
| | - Argyris Stringaris
- From the Department of Health and Human Services, Emotion and Development Branch and Scientific and Statistical Computing Core, NIMH, Bethesda, Md.; the Department of Psychiatry and the Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; the Department of Psychology, Wellesley College, Wellesley, Mass.; the University of Colorado School of Medicine, Aurora, Colo.; the Department of Medicine, Stanford University, Stanford, Calif.; the Departments of Psychology and Neuroscience, University of North Carolina at Chapel Hill; Emory University School of Medicine, Atlanta; the Department of Psychology, University of California at Los Angeles; and University of Michigan Medical School, Ann Arbor
| | - Daniel S Pine
- From the Department of Health and Human Services, Emotion and Development Branch and Scientific and Statistical Computing Core, NIMH, Bethesda, Md.; the Department of Psychiatry and the Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; the Department of Psychology, Wellesley College, Wellesley, Mass.; the University of Colorado School of Medicine, Aurora, Colo.; the Department of Medicine, Stanford University, Stanford, Calif.; the Departments of Psychology and Neuroscience, University of North Carolina at Chapel Hill; Emory University School of Medicine, Atlanta; the Department of Psychology, University of California at Los Angeles; and University of Michigan Medical School, Ann Arbor
| | - Melissa A Brotman
- From the Department of Health and Human Services, Emotion and Development Branch and Scientific and Statistical Computing Core, NIMH, Bethesda, Md.; the Department of Psychiatry and the Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; the Department of Psychology, Wellesley College, Wellesley, Mass.; the University of Colorado School of Medicine, Aurora, Colo.; the Department of Medicine, Stanford University, Stanford, Calif.; the Departments of Psychology and Neuroscience, University of North Carolina at Chapel Hill; Emory University School of Medicine, Atlanta; the Department of Psychology, University of California at Los Angeles; and University of Michigan Medical School, Ann Arbor
| | - Ellen Leibenluft
- From the Department of Health and Human Services, Emotion and Development Branch and Scientific and Statistical Computing Core, NIMH, Bethesda, Md.; the Department of Psychiatry and the Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; the Department of Psychology, Wellesley College, Wellesley, Mass.; the University of Colorado School of Medicine, Aurora, Colo.; the Department of Medicine, Stanford University, Stanford, Calif.; the Departments of Psychology and Neuroscience, University of North Carolina at Chapel Hill; Emory University School of Medicine, Atlanta; the Department of Psychology, University of California at Los Angeles; and University of Michigan Medical School, Ann Arbor
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Ricketts EJ, Snorrason Í, Kircanski K, Alexander JR, Thamrin H, Flessner CA, Franklin ME, Piacentini J, Woods DW. A latent profile analysis of age of onset in pathological skin picking. Compr Psychiatry 2018; 87:46-52. [PMID: 30199665 PMCID: PMC6261272 DOI: 10.1016/j.comppsych.2018.08.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 08/02/2018] [Accepted: 08/13/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Pathological Skin Picking (PSP) may begin at any age, but the most common age of onset is during adolescence. Age of onset is a potentially useful clinical marker to delineate subtypes of psychiatric disorders. The present study sought to examine empirically defined age of onset groups in adults with PSP and assess whether groups differed on clinical characteristics. METHOD Participants were 701 adult respondents to an internet survey, who endorsed recurrent skin picking with tissue damage and impairment. Latent profile analysis (LPA) was conducted to identify subtypes of PSP based on age of onset. Then subgroups were compared on demographic and clinical characteristics. RESULTS The best fitting LPA model was a two-class solution comprised of a large group with average age of onset in adolescence (n = 650; 92.9% of the sample; Mean age of onset = 13.6 years) and a small group with average onset in middle adulthood (n = 50; 7.1% of the sample; Mean age of onset = 42.8 years). Relative to the early onset group, the late onset group reported significantly less focused picking, less skin picking-related impairment, lower rates of co-occurring body-focused repetitive behaviors, and trends towards reduced family history of PSP. Individuals in the late onset group also reported increased rates of comorbid depression, anxiety and posttraumatic stress disorder, and were more likely to report that initial picking onset seemed related to or followed depression/anxiety and physical illness. CONCLUSION Findings suggest the presence of two distinct PSP age of onset groups: (1) an early onset group with average onset in adolescence, clinical characteristics suggestive of greater picking-related burden and familiality, and a profile more representative of the general PSP population; and (2) a late onset group with average onset in middle adulthood, increased co-occurring affective and trauma conditions, and initial onset associated with or following other mental health and physical problems. Future replication is needed to assess the validity and clinical utility of these subgroups.
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Affiliation(s)
- Emily J Ricketts
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, Los Angeles, CA, United States of America.
| | - Ívar Snorrason
- Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, United States of America; Department of Psychiatry, Columbia University Medical Center, New York, NY, United States of America
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States of America
| | - Jennifer R Alexander
- Department of Psychology, Marquette University, Milwaukee, WI, United States of America
| | - Hardian Thamrin
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Christopher A Flessner
- Department of Psychological Sciences, Kent State University, Kent, OH, United States of America
| | - Martin E Franklin
- Children's Hospital of Philadelphia, University of Pennsylvania, United States of America; Department of Child and Adolescent Psychiatry and Behavioral Sciences, Philadelphia, PA, United States of America
| | - John Piacentini
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Douglas W Woods
- Department of Psychology, Marquette University, Milwaukee, WI, United States of America
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Karalunas SL, Gustafsson HC, Fair D, Musser ED, Nigg JT. Do we need an irritable subtype of ADHD? Replication and extension of a promising temperament profile approach to ADHD subtyping. Psychol Assess 2018; 31:236-247. [PMID: 30359050 DOI: 10.1037/pas0000664] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is emblematic of unresolved heterogeneity in psychiatric disorders-the variation in biological, clinical, and psychological correlates that impedes progress on etiology. One approach to this problem is to characterize subgroups using measures rooted in biological or psychological theory, consistent with the National Institute of Mental Health's research domain criteria initiative. Within ADHD, a promising application involves using emotion trait profiles that can address the role of irritability as a complicating feature for ADHD. Here, a new sample of 186 children with ADHD was evaluated using community detection analysis to determine if meaningful subprofiles existed and if they replicated those previously identified. The new sample and a prior sample were pooled for evaluation of (a) method dependence, (b) longitudinal assessment of the stability of classifications, and (c) clinical prediction 2 years later. Three temperament profiles were confirmed within the ADHD group: one with normative emotional functioning ("mild"), one with high surgency ("surgent"), and one with high negative affect ("irritable"). Profiles were similar across statistical clustering approaches. The irritable group had the highest external validity: It was moderately stable over time and it enhanced prospective prediction of clinical outcomes beyond standard baseline indicators. The irritable group was not reducible to ADHD + oppositional defiant disorder, ADHD + disruptive mood dysregulation disorder, or other patterns of comorbidity. Among the negative affect domains studied, trait proneness to anger uniquely contributed to clinical prediction. Results extend our understanding of chronic irritability in psychiatric disorders and provide prospects for a fresh approach to assessing ADHD heterogeneity focused on the distinction between ADHD with and without anger/irritability. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | - Damien Fair
- Department of Psychiatry, Oregon Health & Science University
| | - Erica D Musser
- Department of Psychology, Florida International University
| | - Joel T Nigg
- Department of Psychiatry, Oregon Health & Science University
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Abstract
OBJECTIVE Naturalistic studies suggest that expectation of adverse experiences such as pain exerts particularly strong effects on anxious youth. In healthy adults, expectation influences the experience of pain. The current study uses experimental methods to compare the effects of expectation on pain among adults, healthy youth, and youth with an anxiety disorder. METHODS Twenty-three healthy adults, 20 healthy youth, and 20 youth with an anxiety disorder underwent procedures in which auditory cues were paired with noxious thermal stimulation. Through instructed conditioning, one cue predicted low-pain stimulation and the other predicted high-pain stimulation. At test, each cue was additionally followed by a single temperature calibrated to elicit medium pain ratings. We compared cue-based expectancy effects on pain across the three groups, based on cue effects on pain elicited on medium heat trials. RESULTS Across all groups, as expected, participants reported greater pain with increasing heat intensity (β = 2.29, t(41) = 29.94, p < .001). Across all groups, the critical medium temperature trials were rated as more painful in the high- relative to low-expectancy condition (β = 1.72, t(41) = 10.48, p < .001). However, no evidence of between-group differences or continuous associations with age or anxiety was observed. CONCLUSIONS All participants showed strong effects of expectancy on pain. No influences of development or anxiety arose. Complex factors may influence associations among anxiety, development, and pain reports in naturalistic studies. Such factors may be identified using experiments that employ more complex, yet controlled manipulations of expectancy or assess neural correlates of expectancy.
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Developmental relations between amygdala volume and anxiety traits: Effects of informant, sex, and age. Dev Psychopathol 2017; 30:1503-1515. [DOI: 10.1017/s0954579417001626] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AbstractAlthough substantial human and animal evidence suggests a role for the amygdala in anxiety, literature linking amygdala volume to anxiety symptomatology is inconclusive, with studies finding positive, negative, and null results. Clarifying this brain–behavior relation in middle to late childhood is especially important, as this is a time both of amygdala structural maturation and the emergence of many anxiety disorders. The goal of the current study was to clarify inconsistent findings in previous literature by identifying factors moderating the relation between amygdala volume and anxiety traits in a large sample of typically developing children aged 6–13 years (N = 72). In particular, we investigated the moderating effects of informant (parent vs. child), age, and sex. We found that children's reports (i.e., self-reports) were related to amygdala volume; children who reported higher anxiety levels had smaller amygdalae. This negative relation between amygdala volume and anxiety weakened with age. There was also an independent effect of sex, such that relations were stronger in males than in females. These results indicate the importance of considering sample and informant characteristics when charting the neurobiological mechanisms underlying developmental anxiety.
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Michalska KJ, Machlin L, Moroney E, Lowet DS, Hettema JM, Roberson-Nay R, Averbeck BB, Brotman MA, Nelson EE, Leibenluft E, Pine DS. Anxiety symptoms and children's eye gaze during fear learning. J Child Psychol Psychiatry 2017; 58:1276-1286. [PMID: 28736915 PMCID: PMC9673016 DOI: 10.1111/jcpp.12749] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND The eye region of the face is particularly relevant for decoding threat-related signals, such as fear. However, it is unclear if gaze patterns to the eyes can be influenced by fear learning. Previous studies examining gaze patterns in adults find an association between anxiety and eye gaze avoidance, although no studies to date examine how associations between anxiety symptoms and eye-viewing patterns manifest in children. The current study examined the effects of learning and trait anxiety on eye gaze using a face-based fear conditioning task developed for use in children. METHODS Participants were 82 youth from a general population sample of twins (aged 9-13 years), exhibiting a range of anxiety symptoms. Participants underwent a fear conditioning paradigm where the conditioned stimuli (CS+) were two neutral faces, one of which was randomly selected to be paired with an aversive scream. Eye tracking, physiological, and subjective data were acquired. Children and parents reported their child's anxiety using the Screen for Child Anxiety Related Emotional Disorders. RESULTS Conditioning influenced eye gaze patterns in that children looked longer and more frequently to the eye region of the CS+ than CS- face; this effect was present only during fear acquisition, not at baseline or extinction. Furthermore, consistent with past work in adults, anxiety symptoms were associated with eye gaze avoidance. Finally, gaze duration to the eye region mediated the effect of anxious traits on self-reported fear during acquisition. CONCLUSIONS Anxiety symptoms in children relate to face-viewing strategies deployed in the context of a fear learning experiment. This relationship may inform attempts to understand the relationship between pediatric anxiety symptoms and learning.
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Affiliation(s)
- Kalina J. Michalska
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD,Department of Psychology, University of California Riverside, Riverside, CA
| | - Laura Machlin
- Department of Psychology and Neuroscience, University of North Carolina Chapel Hill, Chapel Hill, NC
| | - Elizabeth Moroney
- Department of Psychology, University of California Los Angeles, Los Angeles, CA
| | | | - John M. Hettema
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA
| | - Roxann Roberson-Nay
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA
| | - Bruno B. Averbeck
- Laboratory of Neuropsychology, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Melissa A. Brotman
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Eric E. Nelson
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD,Center for Biobehavioral Health, The Research Institute, Nationwide Children’s Hospital, Columbus, OH,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Daniel S. Pine
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
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