The neurobiological effects of stress on adolescent decision making

Sex differences in oxycodone-taking behaviors are linked to disruptions in reward-guided, decision-making functions

Problematic opioid use that emerges in a subset of individuals may be due to pre-existing disruptions in the biobehavioral mechanisms that regulate drug use. The identity of these mechanisms is not known, but emerging evidence suggests that suboptimal decision-making that is observable prior to drug use may contribute to the pathology of addiction and, notably, serve as a powerful phenotype for interrogating biologically based differences in opiate-taking behaviors. The current study investigated the relationship between decision-making phenotypes and opioid-taking behaviors in male and female Long Evans rats. Adaptive decision-making processes were assessed using a probabilistic reversal-learning task and oxycodone- (or vehicle, as a control) taking behaviors assessed for 32 days using a saccharin fading procedure that promoted dynamic intake of oxycodone. Tests of motivation, extinction, and reinstatement were also performed. Computational analyses of decision-making and opioid-taking behaviors revealed that attenuated reward-guided decision-making was associated with greater self-administration of oxycodone and addiction-relevant behaviors. Moreover, pre-existing impairments in reward-guided decision-making observed in female rats was associated with greater oxycodone use and addiction-relevant behaviors when compared to males. These results provide new insights into the biobehavioral mechanisms that regulate opiate-taking behaviors and offer a novel phenotypic approach for interrogating sex differences in addiction susceptibility and opioid use disorders.

Fifty years of executive control research in attention-deficit/hyperactivity disorder:What we have learned and still need to know

For 50 years, attention-deficit/hyperactivity disorder (ADHD) has been considered a disorder of executive control (EC), the higher-order, cognitive skills that support self-regulation, goal attainment and what we generally call "attention." This review surveys our current understanding of the nature of EC as it pertains to ADHD and considers the evidence in support of eight hypotheses that can be derived from the EC theory of ADHD. This paper provides a resource for practitioners to aid in clinical decision-making. To support theory building, I draw a parallel between the EC theory of ADHD and the common gene-common variant model of complex traits such as ADHD. The conclusion offers strategies for advancing collaborative research.

A cross-national comparison of the linkages between family structure histories and early adolescent substance use

Family structure can influence adolescent health with cascading implications into adulthood. Life course theory emphasizes how this phenomenon is dynamic across time, contextualized in policy systems, and grounded in processes of selection and socialization. This study used data from the U.S. (National Longitudinal Survey of Youth 1979 Child and Young Adults, n = 6,236) and U.K. (Millennium Cohort Study, n = 11,095) to examine associations between a single mother family structure between ages 0-14 and early adolescent substance use at age 14 across time and place, using inverse probability of treatment weighting to explore how results varied by selection into family structure. In both countries, single parenthood, regardless of its timing during childhood, consistently predicted adolescent substance use when samples were re-weighted to resemble the overall population. However, when samples were re-weighted so that their background characteristics resembled those of actual single parent families, there was little evidence that single parenting posed risks, suggesting that single parenting might matter less for adolescents who are likely to experience it (and vice versa). In addition, more generous welfare policy in the U.K. than in the U.S. did not appear to have ameliorated the observed role of single parenting in adolescent substance use. Findings supported a model of disadvantage saturation, where single parenting has little additional impact over the myriad other disadvantages that single parent families tend to experience, rather than a model of cumulative disadvantage, where single parenting compounds or adds to other disadvantages. Policy and interventions might more valuably focus on these other disadvantages than on family structure.

A trauma-informed approach to understanding firearm decision-making among Black adolescents: Implications for prevention

Firearm violence remains a public health crisis in marginalized, urban communities, with Black adolescents bearing the burden of firearm homicides and injuries. As such, the prevention of firearm violence among adolescents has moved to a high priority of the U.S. public health agenda. The current paper reviews recent literature to highlight the heterogeneity in firearm behavior among Black adolescents and underscore the need for additional research on decision-making and firearm behavior to better understand how adolescents make decisions to acquire, carry, and use firearms. Through a discussion of the disproportionate levels of trauma exposure and trauma symptoms experienced by Black adolescents, the current paper also proposes a trauma-informed approach to understanding decision-making for risky firearm behavior. We discuss the broader impacts of this approach, including the development of a more comprehensive and contextually relevant understanding of the variability in risky firearm behavior and improvements in risk screening capabilities and preventive intervention strategies.

Potentially avoidable interfacility transfers following reduced emergency department volumes due to COVID-19 "Safer-at-Home" orders

OBJECTIVES

We sought to assess if a state-wide lockdown implemented due to COVID-19 was associated with increased odds of being a potentially avoidable transfer (PAT).

METHODS

We conducted a retrospective observational analysis using hospital administrative data of interfacility ED-to-ED transfers to a single, quaternary care adult ED after "Safer at Home" orders were issued March 23rd, 2020 in [Blinded for submission]. Using the PAT classification to identify transfers rapidly discharged from the ED or hospital and may not require in-person care, we used a multivariable logistic regression model to examine the association of the lockdown order with odds of a transfer being a PAT. We compared the period January 1, 2018 to March 23, 2020 with March 24, 2020 to September 30, 2020, adjusting for seasonality, patient, and situational factors.

RESULTS

There were 20,978 ED-to-ED transfers from during this period that were eligible and 4806 (23%) that met PAT criteria. While the first month post-lockdown saw a decrease in PATs (28%), this was not sustained. In the multivariable model there was a significant seasonal effect; May through September had the highest number of transfers as well as PATs. After adjusting for seasonality, the lockdown was not associated with PATs (adjusted odds ratio [aOR] 0.99, 95% CI 0.2, 5.2) and PATs decreased over time.

CONCLUSIONS

We did not find an effect of the COVID-19 lockdown on PATs though there was a considerable seasonal effect and an overall downward trend in PATs over time.

A Longitudinal Process Model Evaluating the Effects of Cooperative Learning on Victimization, Stress, Mental Health, and Academic Engagement in Middle School

Mental health is a significant concern among young people, particularly during the COVID-19 pandemic. Notably, mental health problems can significantly reduce student performance in school, including both engagement and achievement. Both mental health problems and reduced student performance often arise due to peer victimization, which can include teasing, racial- or gender-based discrimination, and/or physical assault. Stress has been proposed as one mechanism through which victimization influences mental health, and stress can also interfere with academic performance at school, including engagement and achievement. To date, however, no research has evaluated longitudinal associations between victimization and stress, and how these longitudinal patterns may impact adolescent behavior and mental health. In this study, we used data from a 2-year cluster randomized trial of cooperative learning to evaluate an etiological process model that includes (1) longitudinal reciprocal effects between victimization and stress, and (2) the effects of both victimization and stress on student mental health and academic engagement. We hypothesized that victimization and stress would have significant reciprocal effects, and that both would predict greater mental health problems and lower academic engagement. We further hypothesized that cooperative learning would have significant effects on all constructs. We found partial support for this model, whereby stress predicted greater victimization, but victimization did not predict increased stress. While both factors were linked to student outcomes, stress was a more powerful predictor. We also found significant salutary effects of cooperative learning on all constructs. The implications of these results for student behavioral and mental health are discussed.

Learned self-regulation in top-level managers through neurobiofeedback training improves decision making under stress

Top-level management teams are particularly exposed to stress factors as they frequently have to make important decision under stress. While an existing body of research evidence suggests that stress negatively affects decision-making processes, very little is known about possible strategies to reduce these negative effects. The aim of the current work is to investigate the effect of training self-regulation ability through neurobiofeedback on managers' intertemporal and risky decision making. Twenty-three managers were assigned to the experimental or the control condition. All participants performed, two decisional tasks, before and after a training phase. The tasks were administered through mouse tracker software, in order to measure participants' delay discounting and risk taking propensity on both explicit and implicit choice parameters. During the training phase, the experimental condition received a training protocol based on stress assessment tests via neurobiofeedback signals (i.e., temperature and skin conductance), with the goal of improving self-regulation ability while the control condition was administered a control training. The main result of this study is to have conclusively demonstrated that NBF training increases an individual's ability to self-regulate stress-related psychophysiological phenomena. Consequently, the improved ability to manage one's own reaction to stress enables a reduction in instinctive behavior during a probabilistic choice task.

Individual differences in accumbofrontal tract integrity relate to risky decisions under stress in adolescents and adults

Psychosocial stress increases risky decision-making (DM). It is widely accepted that individual variation in neural phenotypes underlie variability in this behavioral tendency in adults, but is less examined in adolescents. Our goal was to test the hypothesis that the relation between neural phenotypes and stress-related risky DM is better characterized by individual variation than by age. Using diffusion tensor imaging (DTI) tractography to characterize the accumbofrontal tract, we determined if it uniquely moderated how stress affects risky DM, over and above age. A daily diary design monitored participants’ daily stress for two weeks. Participants completed a DTI scan and performed a task in which decisions varied by expected value, once each on a day when they endorsed feeling higher (and lower) than usual levels of stress. Multilevel logistic regression analyses revealed that all participants were more likely to take risks as expected reward value increased; this behavior was greater under high versus low stress for individuals with low accumbofrontal tract integrity, whereas DM was less influenced by stress for individuals with high accumbofrontal tract integrity, regardless of age. Results suggest that individual differences in brain structure may be more germane to characterizing risky decisions in adolescents, rather than ontogeny.

THE IOWA GAMBLING TASK IN VIOLENT AND NONVIOLENT INCARCERATED MALE ADOLESCENTS

Previous studies have found impaired affective decision-making, as measured by the Iowa Gambling Task (IGT), in various antisocial populations. This is the first study to compare the IGT in violent and nonviolent incarcerated American youth. The IGT was administered to 185 incarcerated adolescent male offenders charged with either nonviolent (38.4%) or violent (61.6%) crimes. General linear mixed models and t tests were used to assess differences between the groups. The full sample performed worse than if they had selected from the decks at random. The violent offenders performed more poorly than the nonviolent offenders overall, primarily because they preferred "disadvantageous" Deck B to a greater degree; however, they did demonstrate some degree of learning by the final block of the task. Adolescent offenders demonstrate impaired affective decision-making. Behavior suggested preferential attention to frequency of loss and amount of gain and inattention to amount of loss.

Are Mid-Adolescents Prone to Risky Decisions? The Influence of Task Setting and Individual Differences in Temperament

Recent developmental models assume a higher tendency to take risks in mid-adolescence, while the empirical evidence for this assumption is rather mixed. Most of the studies applied quite different tasks to measure risk-taking behavior and used a narrow age range. The main goal of the present study was to examine risk-taking behavior in four task settings, the Treasure Hunting Task (THT) in a gain and a loss domain, the Balloon Analogue Risk Task (BART), and the STOPLIGHT task. These task settings differ in affective task moderators, like descriptive vs. experienced outcomes, anticipation of gains vs. losses, static vs. dynamic risk presentation, and time pressure vs. no time pressure and were applied in a sample of 187 participants from age 9-18. Beneath age trends, we were interested in their association with individual differences in approach behavior, venturesomeness, impulsivity, and empathy above age, gender, and fluid intelligence. Our findings revealed that risk-taking behavior is only low to moderately correlated between the four task contexts, suggesting that they capture different aspects of risk-taking behavior. Accordingly, a mid-adolescent peak in risk propensity was only found under time pressure in the STOPLIGHT that was associated with higher impulsivity and empathy. In contrast, risky decisions decreased with increasing age in task settings, in which losses were anticipated (THT Loss), and this was associated with higher cognitive abilities. We found no age differences when gains were anticipated, neither in a static (THT Gain) nor in a dynamic task setting (BART). These findings clearly suggest the need to consider affective task moderators, as well as individual differences in temperament and cognitive abilities, in actual models about adolescent development.

Child Maltreatment and Body Mass Index over Time: The Roles of Social Support and Stress Responses

An unhealthy body mass index (BMI) trajectory can exacerbate the burdens associated with child maltreatment. However, we have yet to explain why the relationship between maltreatment and BMI trajectories exists and what allows individuals to attain healthy BMI trajectories despite adversity. Guided by the Transactional Model of Stress and Coping, we evaluated (1) if peer friendship and adult mentors moderate, and (2) if impulsivity and depressive symptoms mediate, the relationship between maltreatment experiences and average excess BMI. We used data from four waves of the National Longitudinal Study of Adolescent to Adult Health (n = 17,696), following adolescents from ages 13-21 (Wave I) to 24-31 years (Wave IV). We did not find evidence of significant moderation or mediation of the maltreatment experience to average excess BMI relationship. However, models did demonstrate a relationship between peer friendship quality and average excess BMI, such that higher quality protected against higher average excess BMI (B = -0.073, s.e. = 0.02, p < 0.001). Age of maltreatment onset was also associated with average excess BMI, such that maltreatment onset in adolescence was associated with a higher average excess BMI (B = 0.275-0.284, s.e. = 0.11, p = 0.01). Although we found no evidence of moderation by social support or mediation by stress responses of the relationship between maltreatment experiences and average excess BMI, peer friendship appears to protect against higher average excess BMI from adolescence to young adulthood for all adolescents. Future public health interventions should consider how to leverage friendship in obesity prevention efforts.

Socioeconomic hardship and delayed reward discounting: Associations with working memory and emotional reactivity

Prolonged exposure to socioeconomic hardship (SH) is associated with greater delayed reward discounting (DRD), a form of impulsive decision-making that reflects a reduced capacity to delay gratification and a significant correlate of diverse risk behaviors, but the neurobehavioral mechanisms linking SH and DRD are unknown. An emerging hypothesis suggests that cognitive and affective stress associated with poverty may tax neurocognitive functions, such as working memory (WM), and lead to impulsive DRD. Furthermore, research suggests that emotional reactivity (ER) is an important dispositional factor to consider in the link between executive functions and DRD. Thus, we longitudinally examined the indirect effect of SH on impulsive DRD via a network of brain regions associated with WM function in a sample of young adults, and whether that link was moderated by ER. Participants were 119 rural African Americans (aged 19–24 years) assessed behaviorally on four occasions, with fMRI at the last time point. Results showed that, among emerging adults with higher ER, SH severity was predictive of increased DRD via reduced response in brain regions activated during an n-back WM task. These findings reveal both the cognitive and affective mechanisms that underlie the relationship between SH and DRD.

Moderated mediation of the link between parent-adolescent conflict and adolescent risk-taking: The role of physiological regulation and hostile behavior in an experimentally controlled investigation

Compared to childhood and adulthood, adolescence is a time of greater risk-taking behavior, potentially resulting in serious consequences. Theories of adolescent brain development highlight the imbalance between neural circuitry for reward vs. regulation. Although this imbalance may make adolescents more vulnerable to impaired decision-making in the context of heightened arousal, not all adolescents exhibit problematic risk behavior, suggesting other factors are involved. Relatedly, parent-adolescent conflict increases in mid-adolescence, and is linked to negative outcomes like substance use related risk-taking. However, the mechanism by which parent-adolescent conflict and risk-taking are linked is still unknown. Therefore, we investigated this association using a multi-method experimental design. Parent-adolescent dyads were randomly assigned to complete a discussion task together on the topic of either the adolescent's dream vacation or an adolescent-identified conflict topic. During the task, adolescent peripheral psychophysiology was measured for later calculation of heart rate variability (HRV), an index of self-regulation. Immediately after the discussion task, adolescents completed a performance-based measure of risk-taking propensity that indexes real-world risk behaviors. We hypothesized that parent-adolescent conflict would predict greater adolescent risk-taking propensity, and that increased behavioral arousal in the context of conflict, coupled with impaired self-regulation, would explain this link. Results indicated no direct effect of parent-adolescent conflict on adolescent risk-taking propensity. However, there was a significant conditional indirect effect: lower HRV, indexing worse regulatory ability, mediated the relation between conflict and risk-taking propensity but only for adolescents exhibiting behavioral arousal during the discussion task. We discuss implications for understanding adolescent risk-taking behavior.

A Cross-Sectional Study of Stress and the Perceived Style of Decision-Making in Clinicians and Patients With Cancer

BACKGROUND AND AIMS

Perceived stress and mindfulness can impact medical decision-making in both patients and clinicians. The aim of this study was to conduct a cross-sectional evaluation of the relationships between stress, mindfulness, self-regulation, perceptions of treatment conversations, and decision-making preferences among clinicians. Also, perceptions of treatment conversations and decision-making preferences among patients with cancer were evaluated.

METHODOLOGY

Survey instruments were developed for clinicians and patients incorporating previously published questions and validated instruments. Institutional review board approval was obtained. Patients, physicians, and advanced practice providers from a tertiary referral center were asked to complete surveys. Continuous variables were evaluated for normality and then bivariate relationships between variables were evaluated using χ2, Fisher's exact test, Cochran-Mantel-Haenszel (CMH) row mean scores differ statistic, or Kruskal-Wallis tests, where appropriate. Significance was defined at P < .05. All tests were conducted using SAS v.9.4.

RESULTS

77 patients and 86 clinicians (60.1% and 43% response rates, respectively) participated in the surveys. More clinicians who reported feeling "great/good" said they always/sometimes had enough time to spend with patients (66.1%) compared to those that hardly ever/never had enough time (26.3%), χ2(1, N = 75) = 6.62, P = .0101; CMH row mean scores differ statistic). Interestingly, 40.3% of patients preferred a paternalistic style of decision-making compared to 6.3% of clinicians, χ2(2, N = 146) = 27.46, P < .0001; χ2 test. Higher levels of dispositional mindfulness (Mindful Attention Awareness Scale) were found among clinicians who reported they felt "great/good" (median = 4.5) as compared to those who reported that they were "definitely stressed/stressed out" (3.3), χ2(2, N = 80) = 10.32, P = .0057; Kruskal-Wallis test. Higher levels of emotional self-regulation (Emotional Regulation Questionnaire-Cognitive Reappraisal facet) were found among clinicians who reported they felt "great/good" (median = 31.0) compared to those who reported that they were "definitely stressed/stressed out" (20.0), χ2(2, N = 79) = 8.88, P = .0118; Kruskal-Wallis test.

CONCLUSION

In order to have meaningful conversations about treatment planning, an understanding of mental well-being and its relationship to decision-making preferences is crucial for both oncology patients and clinicians. Our results show that for clinicians, lower perceived stress was associated with higher levels of mindfulness (experiencing the present moment), emotional self-regulation, and spending more time with patients. Larger prospective studies are needed to validate these findings.

Emergency department provider and facility variation in opioid prescriptions for discharged patients

STUDY OBJECTIVE

To study the variation in opioid prescribing among emergency physicians and facilities for discharged adult ED patients.

METHODS

We conducted a retrospective analysis of ED visits from five U.S. hospitals between January and May 2014 using records from Data to Intelligence (D2i). We examined physician- and facility-level variation in opioid prescription rates for discharged ED patients. We calculated unadjusted opioid prescription rates at the physician and facility levels and used a multivariable mixed-effect logistic regression model to examine within-facility physician variation in opioid prescription adjusting for patient and situational factors including time of presentation, ED census, and physician workload.

RESULTS

In 47,304 visits across five EDs, median patient age was 40 years old (IQR 28,55), and 89% had some form of insurance. There were 17,098 (36%) ED discharges with at least one opioid prescription. The unadjusted facility-level opioid prescription rate ranged from 24%-46%. Among 253 ED physicians, the adjusted opioid prescription rate varied from 22%-76%. Increased physician workload is related to decreased odds of opioid prescription at ED discharge for the lowest (<3 patients) and moderate (6-9 patients) physician workload levels, while the association weakened with increasing levels of workload.

CONCLUSION

There was substantial physician and facility variation in opioid prescription for discharged adult ED patients. Emergency physicians were less likely to prescribe opioids when their workload was lower, and this effect diminished at high workload levels. Understanding situational and other factors that explain this variation is important given the rising U.S. opioid epidemic and the need for urgent intervention.

Decision-making impairment in anorexia nervosa: New insights into the role of age and decision-making style

OBJECTIVE

Patients with anorexia nervosa (AN) often report difficulties in decision making, which may interfere with treatment. The aim of this study was to investigate decision making in a large sample of adolescent and adult patients with AN, by using the Iowa gambling task.

METHOD

Participants were 611 female individuals (310 patients and 301 controls) who underwent neuropsychological and clinical assessment.

RESULTS

Significantly poorer decision-making performance was observed in adult patients, whereas no difference emerged between affected and nonaffected adolescents. Both adolescent and adult patients were characterized by trends for higher levels of attention to losses in comparison with healthy controls. Although healthy adult women exhibited better decision-making performance than healthy adolescents, in AN, there was no improvement of decision making with age. A cluster analysis identified 2 different styles of decision making in both patients and controls: a conservative style and an impulsive style.

DISCUSSION

Our study provides evidence of dysfunctional decision making in adult patients with AN and reveals an association between poor decision making and excessive punishment sensitivity in AN. The clinical and scientific implications of these findings merit further exploration.

Adolescents, neurosciences et prise de décisions médicales : devrions-nous revoir certaines dispositions du Code civil du Québec?

Au Québec, le mineur de 14 ans et plus peut consentir seul aux soins médicaux requis par son état de santé, sauf exception. Or, les données provenant des neurosciences indiquent que : 1) l’acquisition de la « maturité cérébrale » est un processus continu, pouvant durer jusqu’à la mi-vingtaine, et que 2) certaines habiletés décisionnelles de l’adolescent, comme l’évaluation des risques et bénéfices à court et à long terme, seraient différentes de celles des adultes, surtout dans les situations émotivement chargées. Nous soumettons que, dans une perspective de protection de l’intérêt supérieur de l’enfant, la réalité neurophysiologique de l’adolescent devrait être prise en compte en contexte de soins de santé. Ainsi, nous questionnons le caractère adéquat de la présomption de capacité d’exercer un jugement de façon autonome dès l’âge de 14 ans et soulignons l’aspect paradoxal de la possibilité d’une intervention judiciaire en cas de refus de traitement. Nous questionnons également la pertinence de considérations d’âge dans le cadre de la relation entre le médecin et son patient, dès lors que la détermination de la capacité décisionnelle est une composante essentielle de l’obtention d’un consentement libre et éclairé. Enfin, nous questionnons l’exclusion des parents du processus décisionnel, à la fois en regard de leur responsabilité parentale et des bénéfices que peuvent représenter leurs conseils pour l’adolescent. Par conséquent, nous soumettons qu’une évaluation du bien-fondé de l’octroi d’un pouvoir décisionnel à l’adolescent de 14 ans et plus serait souhaitable et qu’un régime uniformisé tout au long de la minorité, avec de possibles exceptions, reflèterait mieux les connaissances scientifiques actuelles.

Blunted cortisol reactivity and risky driving in young offenders - a pilot study

Adolescent risky driving is a significant burden on public health. Young offenders (i.e. under custody and supervision of the criminal justice system) may be particularly vulnerable, but research is scant. Previous work indicated that blunted cortisol reactivity to stress is a marker of risk-taking predisposition, including risky driving. In this study, we hypothesized that young offenders display higher levels of risky driving than a non-offender comparison group, and that cortisol reactivity contributes to the variance in risky driving independent of other associated characteristics (i.e. impulsivity, risk taking, alcohol and drug use). We found that young offenders (n = 20) showed riskier driving in simulation than comparison group (n = 9), and blunted cortisol reactivity was significantly associated with risky driving. The results suggest young offenders are prone to risky driving, and that individual differences in the cortisol stress response may be an explanatory factor.

Assessment of the acquisition of executive function during the transition from adolescence to adulthood in male and female mice

Executive functions (EF) reached full maturity during the transition from adolescence to adulthood. Human studies provide important information about adolescent developmental trajectories; however, little remains known about the neural circuits underlying the acquisition of mature EF. Ethical and technical considerations with human subjects limit opportunities to design experimental studies that allows for an in-depth understanding of developmental changes in neural circuits that regulate cognitive maturation. Preclinical models can offer solutions to this problem. Unfortunately, current rodent models of adolescent development have inherent flaws that limit their translational value. For instance, females are often omitted from studies, preventing the assessment of potential sex-specific developmental trajectories. Furthermore, it remains unclear whether cognitive developmental changes in rodents are similar to those observed in humans. Here, we tested adolescent and adult male and female mice in a neurocognitive battery of assays. Based on this approach, we assessed mice performances within distinct subdomains of EF, and observed similarities with human developmental trajectories. Furthermore, the sex-specific cognitive changes we observed were paralleled by molecular and neural activity changes demonstrating that our approach can be used in future research to assess the contribution of precise neural circuits to adolescent cognitive maturation.

The Benefits and Burdens of Cancer: A Prospective Longitudinal Cohort Study of Adolescents and Young Adults

BACKGROUND

Adolescents and early young adults (AYAs) with cancer are at high risk for poor outcomes. Positive psychological responses such as benefit-finding may buffer the negative impacts of cancer but are poorly understood in this population.

OBJECTIVE

We aimed to prospectively describe the content and trajectory of benefit- and burden-finding among AYAs to develop potential targets for future intervention.

PATIENTS AND METHODS

One-on-one semistructured interviews were conducted with English-speaking AYA patients (aged 14-25 years) within 60 days of diagnosis of a noncentral nervous system malignancy requiring chemotherapy, 6-12 and 12-18 months later. Interviews were coded using directed content analyses with a priori schema defined by existing theoretical frameworks, including changed sense of self, relationships, philosophy of life, and physical well-being. We compared the content, raw counts, and ratios of benefit-to-burden by patient and by time point.

SETTING/SUBJECTS

Seventeen participants at one tertiary academic medical center (mean age 17.1 years, SD = 2.7) with sarcoma (n = 8), acute leukemia (n = 6), and lymphoma (n = 3) completed 44 interviews with >100 hours of transcript-data.

RESULTS

Average benefit counts were higher than average burden counts at each time point; 68% of interviews had a benefit-to-burden ratio >1. Positive changed sense-of-self was the most common benefit across all time points (44% of all reported benefits); reports of physical distress were the most common burden (32%). Longitudinal analyses suggested perceptions evolved; participants tended to focus less on physical manifestations and more on personal strengths and life purpose.

CONCLUSIONS

AYAs with cancer identify more benefits than burdens throughout cancer treatment and demonstrate rapid maturation of perspectives. These findings not only inform communication practices with AYAs but also suggest opportunities for interventions to potentially improve outcomes.

The influence of reported ADHD and substance abuse on suicidal ideation in a non-clinical sample of young men

This study intended to determine whether former and current ADHD symptomatology is associated with suicidal ideation in a non-clinical sample of 18 year old males. We performed a cross sectional descriptive study of 3280 men during the examination for military service. The investigation included a screening for substance abuse, past (WURS) and current (ADHD symptom checklist) ADHD symptomatology and an interview about suicidal ideations. We found a correlation of suicidal ideations with a history of ADHD symptomatology. ADHD symptoms were strongly consistent over time. These results indicate that a history of (diagnosed or undiagnosed) ADHD could be a predictor for suicidal ideations. Surveying a history of ADHD in primary care might help identify subjects at risk for suicidal tendencies.

Stress potentiates decision biases: A stress induced deliberation-to-intuition (SIDI) model

Humans often make decisions in stressful situations, for example when the stakes are high and the potential consequences severe, or when the clock is ticking and the task demand is overwhelming. In response, a whole train of biological responses to stress has evolved to allow organisms to make a fight-or-flight response. When under stress, fast and effortless heuristics may dominate over slow and demanding deliberation in making decisions under uncertainty. Here, I review evidence from behavioral studies and neuroimaging research on decision making under stress and propose that stress elicits a switch from an analytic reasoning system to intuitive processes, and predict that this switch is associated with diminished activity in the prefrontal executive control regions and exaggerated activity in subcortical reactive emotion brain areas. Previous studies have shown that when stressed, individuals tend to make more habitual responses than goal-directed choices, be less likely to adjust their initial judgment, and rely more on gut feelings in social situations. It is possible that stress influences the arbitration between the emotion responses in subcortical regions and deliberative processes in the prefrontal cortex, so that final decisions are based on unexamined innate responses. Future research may further test this 'stress induced deliberation-to-intuition' (SIDI) model and examine its underlying neural mechanisms.